Provider Demographics
NPI:1619075058
Name:LARRY M SCHANUS PA
Entity Type:Organization
Organization Name:LARRY M SCHANUS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:MARVIN
Authorized Official - Last Name:SCHANUS
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:612-910-8391
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 4459103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty