| Kenneth L. Larson, Ph.d., Inc. | |
|
1891 E Roseville Pkwy Ste 100 Roseville CA 95661-7974 | |
| (916) 789-7082 | |
| (916) 797-8840 |
| Full Name | Kenneth L. Larson, Ph.d., Inc. |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 1891 E Roseville Pkwy Ste 100, Roseville, California |
| Authorized Official Name and Position | Kenneth Leroy Larson (PRESIDENT/CEO) |
| Authorized Official Contact | 9167179368 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenneth L. Larson, Ph.d., Inc. 1891 E Roseville Pkwy Ste 100 Roseville CA 95661-7974 Ph: (916) 789-7082 | Kenneth L. Larson, Ph.d., Inc. 1891 E Roseville Pkwy Ste 100 Roseville CA 95661-7974 Ph: (916) 789-7082 |
| NPI Number | 1609396183 |
|---|---|
| Provider Enumeration Date | 06/26/2017 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609396183 | NPI | - | NPPES |
| PSY16221 | Other | CA | CALIFORNIA BOARD OF PSYCHOLOGY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY16221 (California) | Primary |
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