MEDICARE: MS. KRISTINA LAFLEUR SYVERSON LCMHC

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	101YM0800X	Mental Health Counselor	068.0134205	VT

General Provider Information

NPI Number	:	1912531096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTINA LAFLEUR SYVERSON LCMHC

Provider Business Mailing Address
First Line	:	72 AGNES DR
Second Line	:
City	:	HUNTINGTON
State	:	VT
Zip	:	05462-4410
Country	:	US
Telephone Number	:	802-922-7870
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 MAIN ST STE 2
Second Line	:
City	:	ESSEX JUNCTION
State	:	VT
Zip	:	05452-6100
Country	:	US
Telephone Number	:	802-922-7870
Fax Number	:

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

Provider Enumeration Date	:	02/27/2020
Last Update Date	:	02/27/2020

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