MEDICARE: LARSON COUNSELING & WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
4	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1013852961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARSON COUNSELING & WELLNESS

Provider Business Mailing Address
First Line	:	204 JULIETTE PL
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-4517
Country	:	US
Telephone Number	:	337-781-9742
Fax Number	:

Provider Business Practice Location Address
First Line	:	708 W UNIVERSITY AVE STE 200
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-3500
Country	:	US
Telephone Number	:	337-781-9742
Fax Number	:

Authorized Official
Title or Position	:	OWNER/LICENSED PROF. COUNSELOR
Name	:	MR. MIKE DALE LARSON JR.
Credential	:	LPC
Telephone Number	:	337-781-9742

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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