Healthcare Provider Details

I. General information

NPI: 1003420597
Provider Name (Legal Business Name): JOSHUA A. LARSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7322 W RAWSON AVE
FRANKLIN WI
53132-8117
US

IV. Provider business mailing address

7322 W RAWSON AVE
FRANKLIN WI
53132-8117
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-3339
  • Fax: 414-433-9007
Mailing address:
  • Phone: 414-266-3339
  • Fax: 414-433-9007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8120-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: