Provider Demographics
NPI:1629869581
Name:LARSEN, JUSTINE (LPC)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1791 COUNTY HIGHWAY OO
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-5347
Mailing Address - Country:US
Mailing Address - Phone:715-797-2770
Mailing Address - Fax:
Practice Address - Street 1:1791 COUNTY HIGHWAY OO
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-5347
Practice Address - Country:US
Practice Address - Phone:715-797-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7151101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional