| Jeffrey D Larson, Llc | |
|
700 Raymond Ave Suite 130 St. Paul MN 55114 | |
| (612) 895-1513 | |
| Not Available |
| Full Name | Jeffrey D Larson, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 700 Raymond Ave Suite 130, St. Paul, Minnesota |
| Authorized Official Name and Position | Jeffrey D Larson (CLINICAL DIRECTOR) |
| Authorized Official Contact | 6122518206 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jeffrey D Larson, Llc 700 Raymond Ave Suite 130 St. Paul MN 55114 Ph: (612) 895-1513 | Jeffrey D Larson, Llc 700 Raymond Ave Suite 130 St. Paul MN 55114 Ph: (612) 895-1513 |
| NPI Number | 1386251163 |
|---|---|
| Provider Enumeration Date | 09/25/2020 |
| Last Update Date | 10/03/2021 |
| Certification Date | 10/03/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386251163 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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