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Individual

MS. LAUREEN MARIE LARRISON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPC

Contact information

Practice address
705 S 24TH AVE STE 402, WAUSAU, WI 54401-5242
(715) 848-1457
(715) 848-2959
Mailing address
1090 EVANS ST, WAUPACA, WI 54981-2034
(715) 258-2634

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3017-125
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3017-125
LPC STATE LICENSE
WI
05
39787400
WI
Enumeration date
08/08/2006
Last updated
07/09/2007
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