Healthcare Provider Details

I. General information

NPI: 1154712008
Provider Name (Legal Business Name): LARRY NUTTER MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5851 DULUTH ST SUITE #306
GOLDEN VALLEY MN
55422-3946
US

IV. Provider business mailing address

5851 DULUTH ST SUITE #306
GOLDEN VALLEY MN
55422-3946
US

V. Phone/Fax

Practice location:
  • Phone: 612-202-8703
  • Fax: 612-241-1943
Mailing address:
  • Phone: 612-202-8703
  • Fax: 612-241-1943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: