Healthcare Provider Details

I. General information

NPI: 1710361019
Provider Name (Legal Business Name): CATHERINE LARSEN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 15TH AVE S
MINNEAPOLIS MN
55404-3960
US

IV. Provider business mailing address

2300 15TH AVE S
MINNEAPOLIS MN
55404-3960
US

V. Phone/Fax

Practice location:
  • Phone: 612-728-2033
  • Fax: 612-728-2039
Mailing address:
  • Phone: 612-728-2033
  • Fax: 612-728-2039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2488
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: