Provider Demographics
NPI:1124128756
Name:ADAMS LARSEN, MARGO (PHD)
Entity type:Individual
Prefix:DR
First Name:MARGO
Middle Name:
Last Name:ADAMS LARSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2534 17TH AVE S STE E
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5215
Mailing Address - Country:US
Mailing Address - Phone:701-885-4551
Mailing Address - Fax:
Practice Address - Street 1:2534 17TH AVE S STE E
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5215
Practice Address - Country:US
Practice Address - Phone:701-885-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND343103G00000X, 103TB0200X, 103TC2200X, 103TH0100X, 103TM1800X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11920Medicaid
ND21834OtherBCBSND
MN40263900Medicaid
MN308J4LAOtherBCBSMN
NDA005OtherTRICARE
MN40263900Medicaid
ND11920Medicaid