Provider Demographics
NPI:1336688431
Name:BIGELOW, LIA CORYN (LPC, LMHC)
Entity Type:Individual
Prefix:
First Name:LIA
Middle Name:CORYN
Last Name:BIGELOW
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:LIA
Other - Middle Name:CORYN
Other - Last Name:LAVASSAUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LMHC
Mailing Address - Street 1:501 SUPERIOR PL
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-3739
Mailing Address - Country:US
Mailing Address - Phone:561-584-1585
Mailing Address - Fax:
Practice Address - Street 1:110 JFK DR STE 118
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1146
Practice Address - Country:US
Practice Address - Phone:561-812-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL003719-2014101YA0400X
PAPC009337101YP2500X
FLMH17273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional