Active NPI
Larry Edward Terrell, CAC III
- Specialist
- Pueblo, CO
National Provider Identifier
1124237730
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 3164
- Practice address
- 1711 E Evans Ave
Pueblo, CO 81004-3349 - Phone
- (719) 561-9850
- NPI assigned
- May 21, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 3164 | CO | Primary |
Addresses
Primary practice location
1711 E Evans Ave
Pueblo, CO 81004-3349
Mailing address
3470 Baltimore Ave
Pueblo, CO 81008-1520
Phone (719) 545-1181
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 |
|---|---|---|---|
| 3164 | CO | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124237730",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3470 BALTIMORE AVE",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810081520",
"telephone_number": "719-545-1181",
"fax_number": "719-545-4097"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1711 E EVANS AVE",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810043349",
"telephone_number": "719-561-9850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TERRELL",
"first_name": "LARRY",
"middle_name": "EDWARD",
"name_prefix": "Mr.",
"credential": "CAC III",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CO",
"license": "3164",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.