Provider Demographics
NPI:1962288415
Name:LARSON, JULIA GRACE (MS, LPC-MH, LAC)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:GRACE
Last Name:LARSON
Suffix:
Gender:F
Credentials:MS, LPC-MH, LAC
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:GRACE
Other - Last Name:THIELEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:121 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:LENNOX
Mailing Address - State:SD
Mailing Address - Zip Code:57039-2144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3922 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6513
Practice Address - Country:US
Practice Address - Phone:605-549-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH30633101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health