MEDICARE: YVONNE INGRID LARRIER PHD, LPC

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	LPC004700	GA
2	101YM0800X	Mental Health Counselor	39005451A	IN

General Provider Information

NPI Number	:	1417231994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVONNE INGRID LARRIER PHD, LPC

Provider Business Mailing Address
First Line	:	18464 MADRID CT
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46637-2354
Country	:	US
Telephone Number	:	770-862-5768
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 W WESTERN AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46601-2214
Country	:	US
Telephone Number	:	574-315-9981
Fax Number	:

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

Provider Enumeration Date	:	10/03/2011
Last Update Date	:	06/10/2025

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