Provider Demographics
NPI:1750682282
Name:LARSON, ANDREW JOHN
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JOHN
Last Name:LARSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 SHADY RIDGE RD NW
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350
Mailing Address - Country:US
Mailing Address - Phone:320-234-3451
Mailing Address - Fax:320-587-0993
Practice Address - Street 1:155 SHADY RIDGE RD NW
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-1460
Practice Address - Country:US
Practice Address - Phone:320-234-3451
Practice Address - Fax:320-587-0993
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
MN1935106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist