NPIMap

Individual provider Active NPI

Larry Todd Allen, L.P.C.

  • Professional Counselor
  • Poplar Bluff, MO
National Provider Identifier
1053376467
Registry record updated May 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
002436 Issued in MO
Practice address
2725 N Westwood Blvd
Suite 5a
Poplar Bluff, MO 63901-2346
Phone
(573) 785-0333
Fax
(573) 785-0333
NPI assigned
Apr 19, 2006
Last updated
May 24, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 002436 MO Primary

Addresses

Primary practice location

2725 N Westwood Blvd
Suite 5a
Poplar Bluff, MO 63901-2346

Mailing address

2725 N Westwood Blvd
Suite 5a
Poplar Bluff, MO 63901-2346
Phone (573) 785-0333

Other identifiers 4

IdentifierTypeStateIssuer
1053376467OtherMOHEALTHLINK, INC
1053376467MedicaidMO
000000443672OtherMOANTHEM BLUE CROSS BLUE SHIELD
1053376467OtherMOUNITED HEALTHCARE

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

Practice roles

OrganizationSpecialtyStatusNew patients
Solid Rock Christian Counseling, Inc Past Accepting new patients
Solid Rock Christian Counseling, Inc Past Accepting new patients

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306195200000",
    "number": "1053376467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2725 N WESTWOOD BLVD",
            "address_2": "SUITE 5A",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012346",
            "telephone_number": "573-785-0333",
            "fax_number": "573-785-0333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2725 N WESTWOOD BLVD",
            "address_2": "SUITE 5A",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012346",
            "telephone_number": "573-785-0333",
            "fax_number": "573-785-0333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALLEN",
        "first_name": "LARRY",
        "middle_name": "TODD",
        "name_prefix": "Mr.",
        "credential": "L.P.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-19",
        "last_updated": "2011-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "002436",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK, INC",
            "identifier": "1053376467",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053376467",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS BLUE SHIELD",
            "identifier": "000000443672",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1053376467",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Poplar Bluff, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2011; 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.