Individual
DIANE MARY LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3701 SHORELINE DR STE 102, WAYZATA, MN 55391-9591
(952) 314-7533
Mailing address
3701 SHORELINE DR STE 102, WAYZATA, MN 55391-9591
(952) 314-7533
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
02877
MN
Other
Enumeration date
03/06/2024
Last updated
03/06/2024
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