Healthcare Provider Details

I. General information

NPI: 1013852961
Provider Name (Legal Business Name): LARSON COUNSELING & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 W UNIVERSITY AVE STE 200
LAFAYETTE LA
70506-3500
US

IV. Provider business mailing address

204 JULIETTE PL
LAFAYETTE LA
70506-4517
US

V. Phone/Fax

Practice location:
  • Phone: 337-781-9742
  • Fax:
Mailing address:
  • Phone: 337-781-9742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. MIKE DALE LARSON JR.
Title or Position: OWNER/LICENSED PROF. COUNSELOR
Credential: LPC
Phone: 337-781-9742