Individual
DR. GARY YOUNG LARSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
601 WILLOW AVE, COUNCIL BLUFFS, IA 51501-4242
(712) 323-1728
(712) 323-8888
Mailing address
601 WILLOW AVE, COUNCIL BLUFFS, IA 51501-4242
(712) 323-1728
(712) 323-8888
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
116
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0100495
—
IA
Enumeration date
07/07/2006
Last updated
07/08/2007
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