Individual
BRIAN LARSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LPC
Contact information
Practice address
4123 MEACHEM RD, MOUNT PLEASANT, WI 53403-3912
(773) 910-6003
Mailing address
4123 MEACHEM RD, MOUNT PLEASANT, WI 53403-3912
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
180010010
IL
101YP2500X
Professional Counselor
Primary
6467-125
WI
Other
Enumeration date
05/20/2016
Last updated
05/10/2017
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