NPIMap

Organization Active NPI

Kenneth L. Larson, PH.D., Inc.

  • Clinical Psychologist
  • Roseville, CA
National Provider Identifier
1609396183
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY16221 Issued in CA
Legal business name
KENNETH L. LARSON, PH.D., INC.
Practice address
1891 E Roseville Pkwy Ste 100
Roseville, CA 95661-7974
Phone
(916) 789-7082
Fax
(916) 797-8840
NPI assigned
Jun 26, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kenneth Leroy Larson, PH.D.
Title
President/Ceo
Phone
(916) 717-9368

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X PSY16221 CA Primary

Addresses

Primary practice location

1891 E Roseville Pkwy Ste 100
Roseville, CA 95661-7974

Mailing address

1891 E Roseville Pkwy Ste 100
Roseville, CA 95661-7974
Phone (916) 789-7082

Other identifiers 1

IdentifierTypeStateIssuer
PSY16221OtherCACALIFORNIA BOARD OF PSYCHOLOGY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1498435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1609396183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1891 E ROSEVILLE PKWY STE 100",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956617974",
            "telephone_number": "916-789-7082",
            "fax_number": "916-797-8840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1891 E ROSEVILLE PKWY STE 100",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956617974",
            "telephone_number": "916-789-7082",
            "fax_number": "916-797-8840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH L. LARSON, PH.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-26",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "LEROY",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "916-717-9368",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY16221",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA BOARD OF PSYCHOLOGY",
            "identifier": "PSY16221",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.