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Organization
KENNETH L. LARSON, PH.D., INC.
Active
Organization
KENNETH L. LARSON, PH.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH LEROY LARSON PH.D. (PRESIDENT/CEO)
(916) 717-9368
Entity
Organization
Contact information
Practice address
1891 E ROSEVILLE PKWY STE 100, ROSEVILLE, CA 95661-7974
(916) 789-7082
(916) 797-8840
Mailing address
1891 E ROSEVILLE PKWY STE 100, ROSEVILLE, CA 95661-7974
(916) 789-7082
(916) 797-8840
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY16221
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PSY16221
CALIFORNIA BOARD OF PSYCHOLOGY
CA
Enumeration date
06/26/2017
Last updated
07/21/2022
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