Individual
DR. NATHAN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D,, HSPP
Contact information
Practice address
9106 N MERIDIAN ST, SUITE 100, INDIANAPOLIS, IN 46260-1884
(317) 575-9111
(317) 571-4470
Mailing address
9106 N MERIDIAN ST, SUITE 100, INDIANAPOLIS, IN 46260-1884
(317) 575-9111
(317) 571-4470
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20042106A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200888350
—
IN
Enumeration date
12/03/2007
Last updated
09/26/2011
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