Larry Dale Archer, CLINICAL PSYCHOLOGIS
Individual provider Active NPI Clinical Psychologist · Evansville, IN
NPI 1104833284 · NPPES record last updated May 17, 2018
Key facts
- NPI
- 1104833284
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 20040417A (IN)
- Practice address
- Evansville VA Health Care Center
6211 E. Waterford Blvd.
Evansville, IN 47715 - Phone
- (812) 465-6202
- NPI assigned
- Aug 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20040417A | IN | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 20040417A | IN | Yes |
Addresses
Primary practice location
Evansville VA Health Care Center
6211 E. Waterford Blvd.
Evansville, IN 47715
Mailing address
722 Mels Dr
Evansville, IN 47712-9632
Phone (317) 348-5752
Other practice location 1
722 Mels Dr
Evansville, IN 47712-9632
Phone (317) 348-5752
Other practice location 2
1832 Memorial Dr
Clarksville, TN 37043-6311
Phone (931) 056-4020
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100254440B | Medicaid | IN |
Other providers in Evansville, IN
- Lorien Elizabeth Appman
- Apria Healthcare LLC
- Chandra Aravala
- Gabriel Yilma Araya
- Arcadia Health Services, Ic.
- Architects of Human Awareness
- Trey Mychal Ard
- Janie L Arington
- Emilian F Armeanu
- Alfreida Mikaela Armour
All providers in Evansville, IN · Clinical Psychologist in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.