Individual
MRS. JODY B LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, ATRL
Contact information
Practice address
1325 ANGELS PATH, DE PERE, WI 54115-4050
(920) 338-2855
(920) 338-9270
Mailing address
PO BOX 22040, GREEN BAY, WI 54305-2040
(920) 445-7210
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2479-125
WI
221700000X
Art Therapist
62-036
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
497057
NATIONAL BOARD FOR CERTIFIED COUNSELORS
—
Enumeration date
05/21/2007
Last updated
12/29/2023
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