Provider Demographics
NPI:1518208362
Name:LARSON, NICOLE ANDREA (MS, LPC, LPCC)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ANDREA
Last Name:LARSON
Suffix:
Gender:F
Credentials:MS, LPC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 32ND AVE S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5001
Mailing Address - Country:US
Mailing Address - Phone:218-233-7524
Mailing Address - Fax:
Practice Address - Street 1:1026 NP AVE N APT 108
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4694
Practice Address - Country:US
Practice Address - Phone:701-212-7662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2585101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health