Individual
SIDRA ANN LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
1043 E PARK BLVD STE 101, BOISE, ID 83712-7711
(208) 505-9786
Mailing address
1043 E PARK BLVD STE 101, BOISE, ID 83712-7711
(208) 505-9786
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
14237330-6004
UT
101YM0800X
Mental Health Counselor
24404
AZ
101YP2500X
Professional Counselor
Primary
5968
ID
Other
Enumeration date
09/11/2013
Last updated
11/14/2025
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