Active NPI
Melissa Jo Larson, LPC
- Mental Health Counselor
- Burley, ID
National Provider Identifier
1548692155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LPC-5365
- Practice address
- 2311 Park Ave Ste 3
Burley, ID 83318-2104 - Phone
- (208) 678-3555
- Fax
- (208) 678-3556
- NPI assigned
- Aug 6, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LPC-5365 | ID | Primary |
Addresses
Primary practice location
2311 Park Ave Ste 3
Burley, ID 83318-2104
Mailing address
258 S 150 E
Burley, ID 83318-5711
Phone (208) 431-2995
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC-5365 | ID | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375747200000",
"number": "1548692155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "258 S 150 E",
"city": "BURLEY",
"state": "ID",
"postal_code": "833185711",
"telephone_number": "208-431-2995"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2311 PARK AVE STE 3",
"city": "BURLEY",
"state": "ID",
"postal_code": "833182104",
"telephone_number": "208-678-3555",
"fax_number": "208-678-3556"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "MELISSA",
"middle_name": "JO",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-08-06",
"last_updated": "2013-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "ID",
"license": "LPC-5365",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burley, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.