Provider Demographics
NPI:1538693593
Name:LARSSON, KRISTINA (MA, BCBA, LBA)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:
Last Name:LARSSON
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 S GABOURI ST
Mailing Address - Street 2:
Mailing Address - City:SAINTE GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670-1465
Mailing Address - Country:US
Mailing Address - Phone:573-608-0484
Mailing Address - Fax:314-845-3901
Practice Address - Street 1:11140 S TOWNE SQ
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7830
Practice Address - Country:US
Practice Address - Phone:314-845-3900
Practice Address - Fax:314-845-3901
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017010137251S00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No251S00000XAgenciesCommunity/Behavioral Health