Active NPI
Sidra Ann Larson, LCPC
- Professional Counselor
- Boise, ID
National Provider Identifier
1942635735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 5968
- Practice address
- 1043 E Park Blvd Ste 101
Boise, ID 83712-7711 - Phone
- (208) 505-9786
- NPI assigned
- Sep 11, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 14237330-6004 | UT | |
| Mental Health Counselor | 101YM0800X | 24404 | AZ | |
| Professional Counselor | 101YP2500X | 5968 | ID | Primary |
Addresses
Primary practice location
1043 E Park Blvd Ste 101
Boise, ID 83712-7711
Mailing address
1043 E Park Blvd Ste 101
Boise, ID 83712-7711
Phone (208) 505-9786
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 |
|---|---|---|---|
| 24404 | AZ | MD | Mental Health Counselor |
| 14237330-6004 | UT | MD | Mental Health Counselor |
| 5968 | ID | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1378857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1763078400000",
"number": "1942635735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1043 E PARK BLVD STE 101",
"city": "BOISE",
"state": "ID",
"postal_code": "837127711",
"telephone_number": "208-505-9786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1043 E PARK BLVD STE 101",
"city": "BOISE",
"state": "ID",
"postal_code": "837127711",
"telephone_number": "208-505-9786"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "SIDRA",
"middle_name": "ANN",
"credential": "LCPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-09-11",
"last_updated": "2025-11-14",
"certification_date": "2025-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "UT",
"license": "14237330-6004",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "AZ",
"license": "24404",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ID",
"license": "5968",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.