Jeffrey Donald Larson, LADC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Milaca, MN
NPI 1023575263 · NPPES record last updated Apr 15, 2021
Key facts
- NPI
- 1023575263
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 300814 (MN)
- Practice address
- 11735 90TH Ave
Milaca, MN 56353-3894 - Phone
- (612) 251-8206
- NPI assigned
- Feb 25, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 300814 | MN | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jeffrey D Larson, LLC | Past |
Accepting new patients | |
| Your Path, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 300814 | MN | Yes |
Addresses
Primary practice location
11735 90TH Ave
Milaca, MN 56353-3894
Mailing address
11735 90TH Ave
Milaca, MN 56353-3894
Other providers in Milaca, MN
- Martha Karkinen
- Amber Kent
- Sylvia Ann Kosloski
- Christian Dempsey Kruse
- Neil Laitala
- Morgan Rae Lasalle
- Lighthouse Child & Family Services
- Katie Lynn Mason
- Kelly Renae Mau
- Michael
All providers in Milaca, MN · Addiction (Substance Use Disorder) Counselor in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 15, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.