Provider Demographics
NPI:1871760181
Name:JOHN A LARSEN, PHD, LLC
Entity type:Organization
Organization Name:JOHN A LARSEN, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:913-322-4235
Mailing Address - Street 1:5350 W 94TH TER
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66207-2504
Mailing Address - Country:US
Mailing Address - Phone:913-322-4235
Mailing Address - Fax:913-322-4236
Practice Address - Street 1:5350 W 94TH TER
Practice Address - Street 2:SUITE 204
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66207-2504
Practice Address - Country:US
Practice Address - Phone:913-322-4235
Practice Address - Fax:913-322-4236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSMA 1040Medicare PIN