Healthcare Provider Details

I. General information

NPI: 1255245965
Provider Name (Legal Business Name): VICTORIA R LARSON LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MAIN ST FL 5
LA CROSSE WI
54601-9207
US

IV. Provider business mailing address

421 MAIN ST STE 314
LA CROSSE WI
54601-4024
US

V. Phone/Fax

Practice location:
  • Phone: 608-397-0192
  • Fax: 608-883-6364
Mailing address:
  • Phone: 608-397-0192
  • Fax: 608-881-6364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9305-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: