Provider Demographics
NPI:1437105699
Name:LARSON, SCOTT (LPC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:LARSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7234 OGDEN AVE
Mailing Address - Street 2:SUITE 3N
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-2269
Mailing Address - Country:US
Mailing Address - Phone:708-447-2277
Mailing Address - Fax:708-447-2274
Practice Address - Street 1:7234 OGDEN AVE
Practice Address - Street 2:SUITE 3N
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-2269
Practice Address - Country:US
Practice Address - Phone:708-447-2277
Practice Address - Fax:708-447-2274
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional