Individual
MRS. MELISSA JO LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2311 PARK AVE STE 3, BURLEY, ID 83318-2104
(208) 678-3555
(208) 678-3556
Mailing address
258 S 150 E, BURLEY, ID 83318-5711
(208) 431-2995
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-5365
ID
Other
Enumeration date
08/06/2013
Last updated
08/06/2013
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