Provider Demographics
NPI:1518798883
Name:LARSEN, SOPHIA GRACE (PLMHP)
Entity type:Individual
Prefix:MRS
First Name:SOPHIA
Middle Name:GRACE
Last Name:LARSEN
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:MS
Other - First Name:SOPHIA
Other - Middle Name:GRACE
Other - Last Name:HOELZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6837 DUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-1848
Mailing Address - Country:US
Mailing Address - Phone:262-422-2322
Mailing Address - Fax:
Practice Address - Street 1:1541 CENTER PARK RD STE 2
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-1227
Practice Address - Country:US
Practice Address - Phone:402-261-0235
Practice Address - Fax:402-261-0428
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14011101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health