Provider Demographics
NPI:1487531745
Name:LARSON, MIKE DALE JR (LPC)
Entity type:Individual
Prefix:MR
First Name:MIKE
Middle Name:DALE
Last Name:LARSON
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:D
Other - Last Name:LARSON
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:3110 W PINHOOK RD # 20
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3453
Mailing Address - Country:US
Mailing Address - Phone:337-450-9910
Mailing Address - Fax:
Practice Address - Street 1:3110 W PINHOOK RD # 20
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3453
Practice Address - Country:US
Practice Address - Phone:337-450-9910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9186101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health