Healthcare Provider Details

I. General information

NPI: 1760156376
Provider Name (Legal Business Name): KATIE MARIE LARSON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 HIGHWAY 12 E STE 2
WILLMAR MN
56201-5811
US

IV. Provider business mailing address

2320 HIGHWAY 12 E STE 2
WILLMAR MN
56201-5811
US

V. Phone/Fax

Practice location:
  • Phone: 320-214-9692
  • Fax: 320-214-9924
Mailing address:
  • Phone: 320-214-9692
  • Fax: 320-214-9924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2927
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: