Provider Demographics
NPI:1275605388
Name:LARSON, JAMIE (RD, MS, LPC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:RD, MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 METRO BLVD STE 216
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2321
Mailing Address - Country:US
Mailing Address - Phone:612-615-2700
Mailing Address - Fax:952-835-6134
Practice Address - Street 1:7400 METRO BLVD STE 216
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2321
Practice Address - Country:US
Practice Address - Phone:612-615-2700
Practice Address - Fax:952-835-6134
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1363101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health