Healthcare Provider Details

I. General information

NPI: 1780562017
Provider Name (Legal Business Name): DUSTIN LARSON LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 E FRANKLIN AVE STE 103
MINNEAPOLIS MN
55404-2975
US

IV. Provider business mailing address

1213 E FRANKLIN AVE
MINNEAPOLIS MN
55404-2923
US

V. Phone/Fax

Practice location:
  • Phone: 612-872-8086
  • Fax:
Mailing address:
  • Phone: 612-872-8086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: