Larson, Shane Michael

Larson, Shane Michael is an sole proprietor health care provider with primary practice located at 100 S Maple Suite 204, Watertown SD 57201-3678. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Professional is his primary health care specialty. Larson, Shane Michael can be contacted via phone (605) 520-0157.

Contact Information

Primary practice address
100 S Maple Suite 204 Watertown SD 57201-3678
Phone: (605) 520-0157
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X LPCMH2210 South Dakota
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X

Profile Details

NPI number 1679655856
LBN Legal business name Larson, Shane Michael
Credentials M.S., LPC-MH
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 19th, 2006
Last updated Apr 24th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679655856 NPPES
South Dakota MEDICAID 5200010

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