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General NPI Number Information
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NPI Number | 1871760181
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Entity Type | Organization
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Legal Business Name | JOHN A LARSEN, PHD, LLC
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 04/15/2011
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Provider Practice Location Address
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Address Line | 5350 W 94TH TER SUITE 204
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66207-2504
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Country | US
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Telephone | 913-322-4235
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Fax | 913-322-4236
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Provider Business Mailing Address
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Address Line | 5350 W 94TH TER SUITE 204
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66207-2504
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Country | US
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Telephone | 913-322-4235
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Fax | 913-322-4236
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. JOHN A. LARSEN
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Credential | PH.D.
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Telephone | 913-322-4235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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