Provider Demographics
NPI:1518005206
Name:LARSON, STACIE CATHERINE (LPC)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:CATHERINE
Last Name:LARSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9123 SE SAINT HELENS ST STE 270B
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-6801
Mailing Address - Country:US
Mailing Address - Phone:971-285-5426
Mailing Address - Fax:
Practice Address - Street 1:9123 SE SAINT HELENS ST STE 270B
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-6801
Practice Address - Country:US
Practice Address - Phone:971-285-5426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2017-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3631101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional