1447366828 NPI number — CATHERINE J LARSEN MS, LPC-MH, QMHP

Table of content: CATHERINE J LARSEN MS, LPC-MH, QMHP (NPI 1447366828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447366828 NPI number — CATHERINE J LARSEN MS, LPC-MH, QMHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARSEN
Provider First Name:
CATHERINE
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC-MH, QMHP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447366828
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
918 5TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAPID CITY
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57701-3709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-348-6086
Provider Business Mailing Address Fax Number:
605-348-1050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
918 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAPID CITY
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57701-3709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-348-6086
Provider Business Practice Location Address Fax Number:
605-348-1050
Provider Enumeration Date:
08/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LPC-MH2110 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6575880 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".