Provider Demographics
NPI:1043286370
Name:LARSON, RICHARD GIRARD JR (LCPC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GIRARD
Last Name:LARSON
Suffix:JR
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:719 LYNWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-6308
Mailing Address - Country:US
Mailing Address - Phone:331-551-2224
Mailing Address - Fax:815-642-4304
Practice Address - Street 1:1039 COLLEGE AVE.
Practice Address - Street 2:STE. F
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187
Practice Address - Country:US
Practice Address - Phone:331-551-2224
Practice Address - Fax:815-642-4304
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003363101YP2500X
IL180.003363101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional