| Larson Individual And Family Therapy, Llc | |
|
5100 Eden Ave Suite 310 Edina MN 55436-2337 | |
| (952) 405-6093 | |
| (952) 405-6093 |
| Full Name | Larson Individual And Family Therapy, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 5100 Eden Ave, Edina, Minnesota |
| Authorized Official Name and Position | Eric C Larson (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 9524056093 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Larson Individual And Family Therapy, Llc 5100 Eden Ave Suite 310 Edina MN 55436-2337 Ph: (952) 405-6093 | Larson Individual And Family Therapy, Llc 5100 Eden Ave Suite 310 Edina MN 55436-2337 Ph: (952) 405-6093 |
| NPI Number | 1538527262 |
|---|---|
| Provider Enumeration Date | 02/09/2016 |
| Last Update Date | 02/09/2016 |
| Medicare PECOS PAC ID | 0547568297 |
|---|---|
| Medicare Enrollment ID | O20160412002784 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538527262 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 19647 (Minnesota) | Primary |
| Provider Name | Eric D Larson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558700120 PECOS PAC ID: 9234371550 Enrollment ID: I20130815000189 |
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