Provider Demographics
NPI:1881670495
Name:LARSON, NOEL (PHD, LP, LMFT)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:PHD, LP, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 RAYMOND AVE
Mailing Address - Street 2:SUITE 440
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1503
Mailing Address - Country:US
Mailing Address - Phone:651-642-9317
Mailing Address - Fax:
Practice Address - Street 1:821 RAYMOND AVE
Practice Address - Street 2:SUITE 440
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1503
Practice Address - Country:US
Practice Address - Phone:651-642-9317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0822103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN31B14MEOtherBLUE CROSS BLUE SHIELD
MNPS1500OtherAMERICA'S PPO
MN31B15LAOtherBCBS INDIVIDUAL #
MN61-91122OtherMEDICA
MNHP18477OtherHEALTHPARTNERS
MN1009939OtherPREFERRED ONE