Provider Demographics
NPI:1407695075
Name:LARSON, BOBBY LADD
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:LADD
Last Name:LARSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 VAN BUREN ST STE 2634
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-5610
Mailing Address - Country:US
Mailing Address - Phone:405-360-2133
Mailing Address - Fax:
Practice Address - Street 1:2504 E 71ST ST STE C
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5574
Practice Address - Country:US
Practice Address - Phone:405-360-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst