Individual
MRS. TRACY CHARISSE LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A
Contact information
Practice address
15655 COUNTY RD B, HAYWARD, WI 54843-3251
(715) 634-0607
(715) 634-0617
Mailing address
PO BOX 13251, HAYWARD, WI 54843-3251
(715) 634-0607
(715) 634-0617
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
751 - 226
PROFESSIONAL COUNSELOR TRAINING LICENSE
WI
Enumeration date
03/01/2011
Last updated
03/01/2011
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