| Organization Name: | LARSON PSYCHOLOGICAL SERVICES, LLC |
| NPI Number: | 1447609649 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MOLLY LARSON (CLINICAL PSYCHOLOGIST) |
| Mailing Address: | 122 4th Ave Suite 200 Indialantic |
| State: | FL US |
| Postal Code: | 329033112 |
| Phone Number: | 3213273793 |
| Fax Number: | |
| NPI Enumeration Date: | 06/08/2016 |
| NPI Last Update Date: | 06/08/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PY9437 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |