Individual
MRS. DEBRA JOHNSTON LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1370 S COMMERCIAL ST, NEENAH, WI 54956-4636
(920) 722-8150
(920) 722-0142
Mailing address
1370 S COMMERCIAL ST, NEENAH, WI 54956-4636
(920) 722-8150
(920) 722-0142
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
19-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19-123
WISCONSIN LICENSE LCSW
WI
Enumeration date
09/12/2011
Last updated
09/12/2011
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