Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | LP0943 | MN |
N | 103T00000X | Psychologist | LP0943 | MN |
Y | 103G00000X | Clinical Psychologist | LP0943 | MN |
Y | 103TC0700X | Clinical Psychologist | LP0943 | MN |
N | 103TP2701X | Group Psychotherapist | LP0943 | MN |
N | 103TR0400X | Rehabilitation Psychologist | LP0943 | MN |
NPI | 1740226851 |
---|---|
Provider Name | Karen T Larson |
First Address | Golden Valley, MN 55422 |
Second Address | Golden Valley, MN 55422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 27/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
035053200 | (05) | MN |
167670 | UCARE (01) | |
6236955 | UBH (01) | |
6281912 | MEDICA (01) | |
6K899LA | BCBS MINNESOTA (01) | |
963371008570 | PREFERRED ONE (01) | |
HP39217 | HEALTHPARTNERS (01) | |
MA6552110 | SOUTH DAKOTA MA (01) |