Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 343 | ND |
N | 103TC0700X | Clinical Psychologist | 343 | ND |
Y | 102L00000X | Psychologist | 343 | ND |
Y | 103T00000X | Psychologist | 343 | ND |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 343 | ND |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 343 | ND |
N | 103TH0100X | Health Service | 343 | ND |
N | 103TM1800X | Intellectual & Developmental Disabilities | 343 | ND |
NPI | 1124128756 |
---|---|
Provider Name | Dr. Margo Adams Larsen |
First Address | Grand Forks, ND 58201 |
Second Address | Grand Forks, ND 58201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2006 |
Last Update Date | 03/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11920 | (05) | ND |
21834 | BCBSND (01) | ND |
308J4LA | BCBSMN (01) | MN |
40263900 | (05) | MN |
A005 | TRICARE (01) | ND |
P10447 | (02) | ND |