Provider Demographics
NPI:1992289656
Name:LARSEN, SYDNEY SIMPSON (MA, LPC, CADC,)
Entity type:Individual
Prefix:MS
First Name:SYDNEY
Middle Name:SIMPSON
Last Name:LARSEN
Suffix:
Gender:F
Credentials:MA, LPC, CADC,
Other - Prefix:MS
Other - First Name:SYDNEY
Other - Middle Name:SIMPSON
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1199 HARRIS AVE
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48763-9681
Mailing Address - Country:US
Mailing Address - Phone:989-739-1469
Mailing Address - Fax:
Practice Address - Street 1:1199 HARRIS AVE
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-9681
Practice Address - Country:US
Practice Address - Phone:989-739-1469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2-01027101YA0400X
MI6401012237101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)