Healthcare Provider Details

I. General information

NPI: 1073478533
Provider Name (Legal Business Name): CATELYN BETH LARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 ALGON ST
ALBERT LEA MN
56007-2069
US

IV. Provider business mailing address

101 21ST ST SE STE 1
AUSTIN MN
55912-4322
US

V. Phone/Fax

Practice location:
  • Phone: 507-437-6389
  • Fax:
Mailing address:
  • Phone: 507-437-6389
  • Fax: 507-396-4453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number307421
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: