Provider Demographics
NPI:1922191469
Name:LARSEN, NICOLE K (MA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:K
Last Name:LARSEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 ST MARY'S AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3749
Mailing Address - Country:US
Mailing Address - Phone:402-441-6644
Mailing Address - Fax:402-441-8625
Practice Address - Street 1:2200 ST MARY'S AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3749
Practice Address - Country:US
Practice Address - Phone:402-441-6644
Practice Address - Fax:402-441-8625
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2989101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health