Provider Demographics
NPI:1659618650
Name:LARSON, STEPHEN LEE JR (LICSW, MSW)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LEE
Last Name:LARSON
Suffix:JR
Gender:M
Credentials:LICSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 SAINT ANDREWS CT STE 710
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-8815
Mailing Address - Country:US
Mailing Address - Phone:507-386-7121
Mailing Address - Fax:507-344-0690
Practice Address - Street 1:151 SAINT ANDREWS CT STE 710
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-8815
Practice Address - Country:US
Practice Address - Phone:507-386-7121
Practice Address - Fax:507-344-0690
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN182411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical