Provider Demographics
NPI:1235299660
Name:BENGTSON, LARRY RICHARD (MSE, LPCC)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:RICHARD
Last Name:BENGTSON
Suffix:
Gender:M
Credentials:MSE, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 SEQUOIA LN
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-6650
Mailing Address - Country:US
Mailing Address - Phone:651-238-4673
Mailing Address - Fax:
Practice Address - Street 1:121 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-2514
Practice Address - Country:US
Practice Address - Phone:855-454-2463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00105101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional