Individual provider Active NPI

Corey Larue

  • Mental Health Counselor
  • Johnstown, PA
National Provider Identifier
1013426253
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
119 Walnut St
Johnstown, PA 15901-1625
Phone
(814) 534-0745
NPI assigned
Sep 20, 2017
Sex
Male
Sole proprietor
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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

119 Walnut St
Johnstown, PA 15901-1625

Mailing address

119 Walnut St
Johnstown, PA 15901-1625
Phone (814) 534-0745

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, OR2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240129001518 PA Practitioner - Mental Health Counselor 3476906272 Reassigns benefits to 1 organization
I20250103001790 OR Practitioner - Mental Health Counselor 3476906272 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Lifeline Medical Center Mental Health CurrentSince Jan 16, 2024 Accepting new patients

Locations

1915 NE Stucki Ave
Ste 400
Hillsboro, OR 97006
Phone (844) 408-0014

1925 NE Stucki Ave
Ste 150
Hillsboro, OR 97006

500 Galleria Dr
Ste 164
Johnstown, PA 15904

620 Galleria Dr
Johnstown, PA 15904

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GGCGDD/Endpoint/GGCGDD
  • FHIR API: https://api.platform.athenahealth.com/20067/brand/1/csg/1/fhir/r4

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.

NPI Registry JSON

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

{
    "created_epoch": "1505865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1013426253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 WALNUT ST",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159011625",
            "telephone_number": "814-534-0745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 WALNUT ST",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159011625",
            "telephone_number": "814-534-0745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARUE",
        "first_name": "COREY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-20",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnstown, PA

Sources for this page

Verify at the official NPI Registry.