MEDICARE: AMBER MAE LARSEN MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6451024474	MI

General Provider Information

NPI Number	:	1164308151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER MAE LARSEN MA

Provider Business Mailing Address
First Line	:	24407 VARGAS
Second Line	:
City	:	MATTAWAN
State	:	MI
Zip	:	49071-8851
Country	:	US
Telephone Number	:	541-285-0862
Fax Number	:

Provider Business Practice Location Address
First Line	:	4029 W MAIN ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-2763
Country	:	US
Telephone Number	:	541-285-0862
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2025
Last Update Date	:	08/14/2025

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