Active NPI
Debra Johnston Larson, LCSW
- Mental Health Counselor
- Neenah, WI
National Provider Identifier
1851673297
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 19-123
- Practice address
- 1370 S Commercial St
Neenah, WI 54956-4636 - Phone
- (920) 722-8150
- Fax
- (920) 722-0142
- NPI assigned
- Sep 12, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 19-123 | WI | Primary |
Addresses
Primary practice location
1370 S Commercial St
Neenah, WI 54956-4636
Mailing address
1370 S Commercial St
Neenah, WI 54956-4636
Phone (920) 722-8150
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 19-123 | Other | WI | WISCONSIN LICENSE LCSW |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19-123 | WI | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315785600000",
"number": "1851673297",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1370 S COMMERCIAL ST",
"city": "NEENAH",
"state": "WI",
"postal_code": "549564636",
"telephone_number": "920-722-8150",
"fax_number": "920-722-0142"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1370 S COMMERCIAL ST",
"city": "NEENAH",
"state": "WI",
"postal_code": "549564636",
"telephone_number": "920-722-8150",
"fax_number": "920-722-0142"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "DEBRA",
"middle_name": "JOHNSTON",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-12",
"last_updated": "2011-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WI",
"license": "19-123",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WISCONSIN LICENSE LCSW",
"identifier": "19-123",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Neenah, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.