Brian Larsen, MA, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6467-125 Issued in WI

Practice address

4123 Meachem Rd
Mount Pleasant, WI 53403-3912

Phone

(773) 910-6003

NPI assigned

May 20, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Restore Behavioral Health

  • Professional Counselor
  • Elmwood Park, WI
  • NPI 1487288452
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494374400000",
    "number": "1376990291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4123 MEACHEM RD",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534033912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4123 MEACHEM RD",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534033912",
            "telephone_number": "773-910-6003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "BRIAN",
        "credential": "MA, LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-05-20",
        "last_updated": "2017-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "6467-125",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180010010",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Doreen Lambert, OT
• Jonathan Langan, CRNA
• Lauren Lanphere, MS
• Dawn Marie Larkin, RN
• Michael Scott Larrabee
• Matthew T Larsen, D.P.M.
• Tanya Larsen, RDH
• Cheryl Lasselle, DPT
• Billie A Lawler, APNP
• Melissa Melissa Lawson

• Professional Counselor in Mount Pleasant, WI
• Providers in Mount Pleasant, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.