Healthcare Provider Details

I. General information

NPI: 1629170493
Provider Name (Legal Business Name): JULI LARSEN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 N 4TH ST STE 103
LARAMIE WY
82072
US

IV. Provider business mailing address

1575 N 4TH ST STE 103
LARAMIE WY
82072-2091
US

V. Phone/Fax

Practice location:
  • Phone: 307-721-0700
  • Fax:
Mailing address:
  • Phone: 307-721-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1597
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT1210
License Number StateSD
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT-233
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: