Doctor Name: | SHERRI L LARSON |
NPI Number: | 1295062883 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | 180004355 |
Business Practice Address: | 19740 Governors Hwy Suite 117 Flossmoor, IL - 604222084 |
Business Phone Number: | 8662965262 |
Business Fax Number: | 7089579588 |
Mailing Address: | 20 N Clark St, Suite 2650 CHICAGO |
State: | IL |
Postal Code: | 606024109 |
Phone Number: | 8662965260 |
Fax Number: | 3125581570 |
NPI Enumeration Date: | 11/03/2009 |
NPI Last Update Date: | 11/03/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 180004355 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |