Provider Demographics
NPI:1740226851
Name:LARSON, KAREN T (LP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:T
Last Name:LARSON
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:T
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3915 GOLDEN VALLEY ROAD
Mailing Address - Street 2:COURAGE CENTER
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422
Mailing Address - Country:US
Mailing Address - Phone:763-520-0354
Mailing Address - Fax:763-520-0355
Practice Address - Street 1:3915 GOLDEN VALLEY ROAD
Practice Address - Street 2:COURAGE CENTER
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422
Practice Address - Country:US
Practice Address - Phone:763-520-0354
Practice Address - Fax:763-520-0355
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0943103T00000X, 103TP2701X, 103TR0400X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
6236955OtherUBH
MA6552110OtherSOUTH DAKOTA MA
963371008570OtherPREFERRED ONE
6K899LAOtherBCBS MINNESOTA
MN035053200Medicaid
6281912OtherMEDICA
167670OtherUCARE
HP39217OtherHEALTHPARTNERS