Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY 6032 | CA |
N | 103T00000X | Psychologist | PSY 6032 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY 6032 | CA |
Y | 103G00000X | Clinical Psychologist | PSY 6032 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY 6032 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY 6032 | CA |
NPI | 1245240928 |
---|---|
Provider Name | Leon D Larimer II |
First Address | Monterey, CA 93942 |
Second Address | Monterey, CA 93940-5902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 02/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
680015574 | RAILROAD (01) | CA |
R26339 | (02) | CA |