Provider Demographics
NPI:1295473346
Name:JIMMIE JOANN LARSON PC
Entity type:Organization
Organization Name:JIMMIE JOANN LARSON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP
Authorized Official - Phone:402-366-5432
Mailing Address - Street 1:1100 N LINCOLN AVE STE F
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-1743
Mailing Address - Country:US
Mailing Address - Phone:402-759-3802
Mailing Address - Fax:402-759-3803
Practice Address - Street 1:1100 N LINCOLN AVE STE F
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-1743
Practice Address - Country:US
Practice Address - Phone:402-759-3802
Practice Address - Fax:402-759-3803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty