MEDICARE: HEATHER LEIGH LARSON 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	3390	AL
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1689102345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER LEIGH LARSON LPC

Provider Business Mailing Address
First Line	:	2363 ABBEYGLEN CIR
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35226-6216
Country	:	US
Telephone Number	:	205-767-7461
Fax Number	:	888-386-9624

Provider Business Practice Location Address
First Line	:	1235 BLUE RIDGE BLVD STE 109
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35226-2541
Country	:	US
Telephone Number	:	205-767-7461
Fax Number	:

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

Provider Enumeration Date	:	05/25/2017
Last Update Date	:	11/01/2022

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Directions to “ HEATHER LEIGH LARSON LPC” Practice Location

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