Provider Demographics
NPI:1447338702
Name:LARSSON, ERIC (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:LARSSON
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 DEAN PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4470
Mailing Address - Country:US
Mailing Address - Phone:612-925-8365
Mailing Address - Fax:612-925-8366
Practice Address - Street 1:2925 DEAN PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4470
Practice Address - Country:US
Practice Address - Phone:612-925-8365
Practice Address - Fax:612-925-8366
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1531103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0638K3LAOtherBCBS OF MN
MN688548900Medicaid