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NPI Code Detail

MEDICARE: MR. ANDREW JOHN LARSON MS, LPCC, LADC

MEDICARE: MR. ANDREW JOHN LARSON MS, LPCC, LADC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor5535MN

General Provider Information

NPI Number : 1134061096
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ANDREW JOHN LARSON MS, LPCC, LADC
Provider Business Mailing Address
First Line : 14162 DEARBORN PATH
Second Line :
City : ROSEMOUNT
State : MN
Zip : 55068-7123
Country : US
Telephone Number : 651-216-9361
Fax Number :
Provider Business Practice Location Address
First Line : 2000 WHITE BEAR AVE N
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-3713
Country : US
Telephone Number : 651-216-9361
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2026
Last Update Date : 04/08/2026

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