Provider Demographics
NPI:1346560471
Name:LARSON, CAROL A (LMHP, CPC)
Entity Type:Individual
Prefix:MISS
First Name:CAROL
Middle Name:A
Last Name:LARSON
Suffix:
Gender:F
Credentials:LMHP, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 W 46TH ST
Mailing Address - Street 2:STE 204
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8348
Mailing Address - Country:US
Mailing Address - Phone:308-236-2014
Mailing Address - Fax:308-236-6940
Practice Address - Street 1:124 W 46TH ST
Practice Address - Street 2:STE 204
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8348
Practice Address - Country:US
Practice Address - Phone:308-236-2014
Practice Address - Fax:308-236-6940
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1513101YM0800X
NE2049101YP2500X
NE4176101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional