Provider Demographics
NPI:1912954728
Name:LARSEN, NATHANAEL M (PHD)
Entity type:Individual
Prefix:
First Name:NATHANAEL
Middle Name:M
Last Name:LARSEN
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:23355 OAKVIEW HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-8163
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:126 E ALCOTT AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2903
Practice Address - Country:US
Practice Address - Phone:218-736-6987
Practice Address - Fax:218-736-6980
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNLP2878103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP23070OtherHEALTHPARTNER
MN1010714OtherPREFERREDONE
MN62-20513OtherUNITED BEHAVIOR HEALTH
MN57399LAOtherMN BLUE CROSS BLUE SHIELD
MN116689OtherUCARE MINNESOTA