Healthcare Provider Details

I. General information

NPI: 1710240890
Provider Name (Legal Business Name): NATALIE ANN-LOUISE LARSON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 3RD ST S STE 303
STILLWATER MN
55082-8001
US

IV. Provider business mailing address

275 3RD ST. S. STE 303
STILLWATER MN
55082-8001
US

V. Phone/Fax

Practice location:
  • Phone: 651-439-2059
  • Fax: 888-675-8262
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC00482
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: