Basic Information
| Provider Information | |||||||||
| NPI: | 1003420597 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARSON | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7322 W RAWSON AVE | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531328117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142663339 | ||||||||
| FaxNumber: | 4144339007 | ||||||||
| Practice Location | |||||||||
| Address1: | 7322 W RAWSON AVE | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531328117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142663339 | ||||||||
| FaxNumber: | 4144339007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2020 | ||||||||
| LastUpdateDate: | 12/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 8120-125 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.