Provider Demographics
NPI:1619314440
Name:LARSON, LAURENE LEE (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:LAURENE
Middle Name:LEE
Last Name:LARSON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 FIRLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4483
Mailing Address - Country:US
Mailing Address - Phone:541-687-2550
Mailing Address - Fax:
Practice Address - Street 1:1531 PEARL ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4010
Practice Address - Country:US
Practice Address - Phone:541-517-9733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0366101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional