Provider Demographics
NPI:1154712008
Name:NUTTER, LARRY (MA)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:NUTTER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5851 DULUTH ST
Mailing Address - Street 2:SUITE #306
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-3946
Mailing Address - Country:US
Mailing Address - Phone:612-202-8703
Mailing Address - Fax:612-241-1943
Practice Address - Street 1:5851 DULUTH ST
Practice Address - Street 2:SUITE #306
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-3946
Practice Address - Country:US
Practice Address - Phone:612-202-8703
Practice Address - Fax:612-241-1943
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-13
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst