Provider Demographics
NPI:1144416447
Name:ELIZABETH A LARSON INC
Entity Type:Organization
Organization Name:ELIZABETH A LARSON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:605-274-1119
Mailing Address - Street 1:6810 S LYNCREST AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2515
Mailing Address - Country:US
Mailing Address - Phone:605-274-1119
Mailing Address - Fax:605-271-9983
Practice Address - Street 1:6810 S LYNCREST AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2515
Practice Address - Country:US
Practice Address - Phone:605-274-1119
Practice Address - Fax:605-271-9983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD424103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
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SD4905421OtherUNITED BEHAVIORAL HEALTH
SD455505000OtherMAGELLON BEHAVIORAL HEALT
SD4996486OtherBLUE CROSS BLUE SHEILD
SD6551970Medicaid
SD9982OtherMIDLANDS CHOICE
SD22188OtherSANFORD HEALTH
SD7305OtherAVERA HEALTH PLANS
SD4905421OtherUNITED BEHAVIORAL HEALTH