Individual
NATHANAEL M LARSEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
126 E ALCOTT AVE, FERGUS FALLS, MN 56537-2903
(218) 736-6987
(218) 736-6980
Mailing address
23355 OAKVIEW HEIGHTS DR, FERGUS FALLS, MN 56537-8163
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP2878
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1010714
PREFERREDONE
MN
01
—
116689
UCARE MINNESOTA
MN
01
—
57399LA
MN BLUE CROSS BLUE SHIELD
MN
01
—
62-20513
UNITED BEHAVIOR HEALTH
MN
01
—
HP23070
HEALTHPARTNER
MN
Enumeration date
05/27/2006
Last updated
07/08/2007
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