| NPI | 1538202890 |
|---|---|
| Professional Name | NICKEY G LARSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN 1810) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 300756) |
| 106H00000X Marriage & Family Therapist (Licence: MN 466) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2015-11-02 |