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General NPI Number Information
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NPI Number | 1699143677
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Entity Type | Individual
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Provider Name | SAMUEL W LARSON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/09/2015
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Last Update Date | 02/11/2020
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Provider Practice Location Address
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Address Line | 2200 21ST AVE S STE 300
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City | NASHVILLE
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State | TN
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Zip | 37212-4929
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Country | US
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Telephone | 615-933-3571
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Fax |
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Provider Business Mailing Address
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Address Line | 1819A SHACKLEFORD RD
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City | NASHVILLE
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State | TN
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Zip | 37215-3525
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Country | US
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Telephone | 773-351-4913
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Fax |
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3698
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License Number State | TN
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