Individual
MR. ETHAN TAVIS LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
405 CENTRAL AVE, NORTHFIELD, IL 60093-3006
(847) 441-5600
Mailing address
858 N WOLCOTT AVE APT 2, CHICAGO, IL 60622-6791
(626) 466-5812
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
02/21/2022
Last updated
02/21/2022
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