Healthcare Provider Details

I. General information

NPI: 1487732764
Provider Name (Legal Business Name): LOVAAS INSTITUTE FOR EARLY INTERVENTION - MIDWEST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 AMERICAN BLVD W STE 740
BLOOMINGTON MN
55431-4422
US

IV. Provider business mailing address

3800 AMERICAN BLVD W STE 740
MINNEAPOLIS MN
55431-4422
US

V. Phone/Fax

Practice location:
  • Phone: 612-925-8365
  • Fax: 612-925-8366
Mailing address:
  • Phone: 612-925-8365
  • Fax: 612-925-8366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number10211043
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP1531
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC VERNER LARSSON
Title or Position: CLINICAL DIRECTOR
Credential: P.H.D., L.P.
Phone: 612-925-8365