Provider Demographics
NPI:1962951988
Name:LARSON, ELISABETH (MA, LPC)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:2020 DOWNYFLAKE LN
Mailing Address - Street 2:SUITE 201-E
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-4917
Mailing Address - Country:US
Mailing Address - Phone:484-274-9010
Mailing Address - Fax:
Practice Address - Street 1:2020 DOWNYFLAKE LN
Practice Address - Street 2:SUITE 201-E
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-4917
Practice Address - Country:US
Practice Address - Phone:484-274-9010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008983101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional