Active NPI
Larry Anthony Spence
- Marriage & Family Therapist
- Milwaukee, WI
National Provider Identifier
1013153253
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- Practice address
- 5626 N 91St St Ste 301
Milwaukee, WI 53225-2745 - Phone
- (414) 461-1088
- Fax
- (414) 461-1049
- NPI assigned
- Dec 17, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 4152-120 | WI | |
| Social Worker | 104100000X | 4152-120 | WI | |
| Marriage & Family Therapist | 106H00000X | Primary |
Addresses
Primary practice location
5626 N 91St St Ste 301
Milwaukee, WI 53225-2745
Mailing address
5626 N 91St St Ste 301
Milwaukee, WI 53225-2745
Phone (414) 461-1088
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40921600 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4152-120 | WI | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sebastian Family Psychology Practice, LLC | Social Worker | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Glendale, WI
- NPI 1619011046
Social Worker
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1229472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1229472000000",
"number": "1013153253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5626 N 91ST ST STE 301",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532252745",
"telephone_number": "414-461-1088",
"fax_number": "414-461-1049"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5626 N 91ST ST STE 301",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532252745",
"telephone_number": "414-461-1088",
"fax_number": "414-461-1049"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPENCE",
"first_name": "LARRY",
"middle_name": "ANTHONY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-12-17",
"last_updated": "2008-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WI",
"license": "4152-120",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "WI",
"license": "4152-120",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40921600",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.