Provider Demographics
NPI:1629005541
Name:LARSON, JAMES D (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:LARSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 EAST GOVERNMENT STREET
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502
Mailing Address - Country:US
Mailing Address - Phone:850-434-5033
Mailing Address - Fax:850-433-0268
Practice Address - Street 1:600 EAST GOVERNMENT STREET
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502
Practice Address - Country:US
Practice Address - Phone:850-434-5033
Practice Address - Fax:850-433-0268
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2379103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75075ZMedicare PIN