Kenneth L. Larson, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY16221 Issued in CA

Practice address

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

Phone

(916) 789-7082

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Travis H Owens Psy D Inc

  • Clinical Psychologist
  • Roseville, CA
  • NPI 1275762452
  NPD

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662681600000",
    "number": "1891806675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4580 KLAHANIE DR SE",
            "address_2": "PMB 445",
            "city": "SAMMAMISH",
            "state": "WA",
            "postal_code": "980295812",
            "telephone_number": "425-278-9351",
            "fax_number": "425-209-0968"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "KENNETH",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2022-09-09",
        "certification_date": "2022-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY61229677",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY16221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Larkin Martin
• Jenifer N Larkin, RBT
• Erica Larosa, P.T.
• Dolores Raquel Larry
• Cory James Larsen, PHARMD
• Melissa Larson, MS SLP
• Miranda Lynn Larson, CMT NMT
• Rebecca Larussa, M.S., CCC-SLP
• Joanna Marie Lasalle, MS, LH, RS
• Tyler Laster

• Clinical Psychologist in Roseville, CA
• Providers in Roseville, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 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.