Provider Demographics
NPI:1851727366
Name:LARSON, KAREN RUTH (PHD, LPC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:RUTH
Last Name:LARSON
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HUNTINGTON RD STE 801
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-7216
Mailing Address - Country:US
Mailing Address - Phone:706-552-0450
Mailing Address - Fax:706-850-1211
Practice Address - Street 1:1 HUNTINGTON RD STE 801
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-7216
Practice Address - Country:US
Practice Address - Phone:706-552-0450
Practice Address - Fax:706-850-1211
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007263101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional