Individual
DR. MARGO ADAMS LARSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
2534 17TH AVE S STE E, GRAND FORKS, ND 58201-5215
(701) 885-4551
Mailing address
2534 17TH AVE S STE E, GRAND FORKS, ND 58201-5215
(701) 885-4551
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
343
ND
103T00000X
Psychologist
Primary
343
ND
103TB0200X
Cognitive & Behavioral Psychologist
343
ND
103TC2200X
Clinical Child & Adolescent Psychologist
343
ND
103TH0100X
Health Service Psychologist
343
ND
103TM1800X
Intellectual & Developmental Disabilities Psychologist
343
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11920
—
ND
01
—
21834
BCBSND
ND
01
—
308J4LA
BCBSMN
MN
05
—
40263900
—
MN
01
—
A005
TRICARE
ND
Enumeration date
09/24/2006
Last updated
01/19/2023
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