Provider Demographics
NPI:1386658854
Name:LARSON, CYNTHIA RAE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:RAE
Last Name:LARSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6961 UNIVERSITY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50324-1532
Mailing Address - Country:US
Mailing Address - Phone:515-313-8788
Mailing Address - Fax:515-414-7434
Practice Address - Street 1:6961 UNIVERSITY AVE STE A
Practice Address - Street 2:
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50324-1532
Practice Address - Country:US
Practice Address - Phone:515-313-8788
Practice Address - Fax:515-277-6995
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00247101Y00000X
IA95173101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA076170000Medicaid