Provider Demographics
NPI:1457642126
Name:LARSON, SUE (LPC CSAC)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:LPC CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 E MILL ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-2261
Mailing Address - Country:US
Mailing Address - Phone:608-856-5225
Mailing Address - Fax:608-856-5226
Practice Address - Street 1:149 E MILL ST
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-2261
Practice Address - Country:US
Practice Address - Phone:608-856-5225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15722-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)