MEDICARE: MS. CYNTHIA RAE LARSON LMHC

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	101Y00000X	Counselor	00247	IA
2	101Y00000X	Counselor	95173	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386658854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA RAE LARSON LMHC

Provider Business Mailing Address
First Line	:	6961 UNIVERSITY AVE STE A
Second Line	:
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50324-1532
Country	:	US
Telephone Number	:	515-313-8788
Fax Number	:	515-414-7434

Provider Business Practice Location Address
First Line	:	6961 UNIVERSITY AVE STE A
Second Line	:
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50324-1532
Country	:	US
Telephone Number	:	515-313-8788
Fax Number	:	515-277-6995

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	08/25/2021

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