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 1:1900 SILVER LAKE RD NW
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1786
Mailing Address - Country:US
Mailing Address - Phone:612-464-6671
Mailing Address - Fax:651-628-0411
Practice Address - Street 1:13045 FALCON DR STE 100
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-4201
Practice Address - Country:US
Practice Address - Phone:218-282-4746
Practice Address - Fax:218-829-7649
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0943103TR0400X, 103TC0700X, 103T00000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
167670OtherUCARE
963371008570OtherPREFERRED ONE
6236955OtherUBH
6281912OtherMEDICA
MA6552110OtherSOUTH DAKOTA MA
HP39217OtherHEALTHPARTNERS
MN035053200Medicaid
6K899LAOtherBCBS MINNESOTA