NPIMap

Organization Active NPI

Larry Anderson PSYD LLC

  • Psychologist
  • Minneapolis, MN
National Provider Identifier
1841796414
Registry record updated Jun 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
LP4461 Issued in MN
Legal business name
LARRY ANDERSON PSYD LLC
Practice address
2124 Dupont Ave S Ste 202
Minneapolis, MN 55405-2719
Phone
(612) 718-0894
Fax
(612) 879-0059
NPI assigned
Apr 3, 2018
Last updated
Jun 1, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2020

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

Authorized official

Name
Larry L Anderson, PSYDNPI 1356485924
Title
Owner
Phone
(612) 718-0894

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X LP4461 MN Primary

Addresses

Primary practice location

2124 Dupont Ave S Ste 202
Minneapolis, MN 55405-2719

Mailing address

2307 Cleveland St NE
Minneapolis, MN 55418-4020
Phone (612) 718-0894

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1522713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590969600000",
    "number": "1841796414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2307 CLEVELAND ST NE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554184020",
            "telephone_number": "612-718-0894",
            "fax_number": "612-879-0059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2124 DUPONT AVE S STE 202",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554052719",
            "telephone_number": "612-718-0894",
            "fax_number": "612-879-0059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARRY ANDERSON PSYD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-03",
        "last_updated": "2020-06-01",
        "certification_date": "2020-06-01",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-718-0894",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP4461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2020; 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.