Provider Demographics
NPI:1649384801
Name:LARSON, ELIZABETH ANNE (EDD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANNE
Last Name:LARSON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5000 S BROADBAND LN
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2260
Mailing Address - Country:US
Mailing Address - Phone:605-275-2277
Mailing Address - Fax:605-275-2279
Practice Address - Street 1:5000 S BROADBAND LN
Practice Address - Street 2:SUITE 107
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2260
Practice Address - Country:US
Practice Address - Phone:605-275-2277
Practice Address - Fax:605-275-2279
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SDSD424103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
455505000OtherMAGELLAN BEHAVIORAL HEALT
SD6551970Medicaid
SD7305OtherAVERA HEALTH PLANS
SD4996486OtherBLUE CROSS BLUE SHIELD
4905421OtherUNITED BEHAVIORAL HEALTH
9982OtherMIDLANDS CHOICE
102709OtherHEALTH PARTNERS
SD22188OtherSIOUX VALLEY HEALTH PLAN
SD4996486OtherBLUE CROSS BLUE SHIELD