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Individual
MRS. TARA RENAE OLSON-LARSON
Active
Individual
MRS. TARA RENAE OLSON-LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA LPC MH
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC1084
SD
101YM0800X
Mental Health Counselor
LPCMH2120
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6575440
—
SD
Enumeration date
09/26/2005
Last updated
11/16/2007
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