Provider Demographics
NPI:1316535719
Name:LARKIN, EDWARD A (MC, LP)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:A
Last Name:LARKIN
Suffix:
Gender:M
Credentials:MC, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9619 ENSIGN CIR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-1627
Mailing Address - Country:US
Mailing Address - Phone:651-334-7616
Mailing Address - Fax:
Practice Address - Street 1:9619 ENSIGN CIR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55438-1627
Practice Address - Country:US
Practice Address - Phone:651-334-7616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-02
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3685103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling