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General NPI Number Information
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NPI Number | 1538693593
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Entity Type | Individual
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Provider Name | KRISTINA LARSSON MA, BCBA, LBA
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Gender | Female
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Dates
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Enumeration Date | 04/17/2017
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Last Update Date | 12/11/2017
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Provider Practice Location Address
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Address Line | 11140 S TOWNE SQ SUITE 100
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City | SAINT LOUIS
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State | MO
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Zip | 63123-7830
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Country | US
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Telephone | 314-845-3900
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Fax | 314-845-3901
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Provider Business Mailing Address
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Address Line | 1031 S GABOURI ST
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City | SAINTE GENEVIEVE
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State | MO
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Zip | 63670-1465
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Country | US
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Telephone | 573-608-0484
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Fax | 314-845-3901
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2017010137
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 2017010137
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License Number State | MO
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