Individual
EDWARD J LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA., LAPC
Contact information
Practice address
2624 9TH AVE S, FARGO, ND 58103-2350
(701) 298-4500
(701) 298-4400
Mailing address
2624 9TH AVE S, FARGO, ND 58103-2350
(701) 298-4500
(701) 298-4400
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
587-8-1-07A
ND
171M00000X
Case Manager/Care Coordinator
—
—
247200000X
Other Technician
—
—
Other
Enumeration date
08/28/2007
Last updated
09/04/2020
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