Provider Demographics
NPI:1710851191
Name:LARSON, JENNIFER J (LPC-A, CRC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:LARSON
Suffix:
Gender:F
Credentials:LPC-A, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 PEPPERGRASS CV
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-5902
Mailing Address - Country:US
Mailing Address - Phone:512-213-8378
Mailing Address - Fax:
Practice Address - Street 1:148 PEPPERGRASS CV
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-5902
Practice Address - Country:US
Practice Address - Phone:512-213-8378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX98488101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor