Healthcare Provider Details

I. General information

NPI: 1275441727
Provider Name (Legal Business Name): KALLIE LARSEN MS, PLMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3883 NORMAL BLVD STE 204
LINCOLN NE
68506-5218
US

IV. Provider business mailing address

3883 NORMAL BLVD STE 204
LINCOLN NE
68506-5218
US

V. Phone/Fax

Practice location:
  • Phone: 531-249-2324
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15093
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: