Provider Demographics
NPI:1932085917
Name:RUTH A. LARSON, LICENSED MENTAL HEALTH COUNSELOR, PLLC
Entity type:Organization
Organization Name:RUTH A. LARSON, LICENSED MENTAL HEALTH COUNSELOR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:A
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:315-503-3112
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-0203
Mailing Address - Country:US
Mailing Address - Phone:315-503-3112
Mailing Address - Fax:
Practice Address - Street 1:3455 ERIEVILLE RD
Practice Address - Street 2:
Practice Address - City:ERIEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13061-3176
Practice Address - Country:US
Practice Address - Phone:315-503-3112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty