Individual
MATTHEW PAUL LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC, RYT200
Contact information
Practice address
41W400 SILVER GLEN RD, ST CHARLES, IL 60175-8453
(630) 940-1193
Mailing address
41W400 SILVER GLEN RD, ST CHARLES, IL 60175-8453
(630) 940-1193
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
37495
IL
Other
Enumeration date
09/27/2023
Last updated
09/27/2023
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