Provider Demographics
NPI:1295062883
Name:LARSON, SHERRI L (LCPC)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:L
Last Name:LARSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N CLARK ST
Mailing Address - Street 2:SUITE 2650
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-4109
Mailing Address - Country:US
Mailing Address - Phone:866-296-5260
Mailing Address - Fax:312-558-1570
Practice Address - Street 1:19740 GOVERNORS HWY
Practice Address - Street 2:SUITE 117
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2084
Practice Address - Country:US
Practice Address - Phone:866-296-5262
Practice Address - Fax:708-957-9588
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004355101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180004355OtherSTATE OF ILLINOIS