Provider Demographics
NPI:1225046915
Name:SCHANUS, LARRY MARVIN (PSY D)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:MARVIN
Last Name:SCHANUS
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 ARDMORE AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLE PLAIN
Mailing Address - State:MN
Mailing Address - Zip Code:55359-9342
Mailing Address - Country:US
Mailing Address - Phone:612-910-8391
Mailing Address - Fax:763-479-1748
Practice Address - Street 1:21370 JOHN MILLESS DR
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-4621
Practice Address - Country:US
Practice Address - Phone:612-910-8391
Practice Address - Fax:763-479-1748
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4459103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN029G4SCOtherBLUE CROSS BLUE SHIELD