Active NPI
Lynn Dale Larson, PHD
- Clinical Psychologist
- Las Vegas, NV
National Provider Identifier
1356695084
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY137
- Practice address
- 2980 S Rainbow Blvd
Suite 200a
Las Vegas, NV 89146-6531 - Phone
- (702) 315-5670
- Fax
- (702) 315-5672
- NPI assigned
- Nov 2, 2012
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY137 | NV | Primary |
Addresses
Primary practice location
2980 S Rainbow Blvd
Suite 200a
Las Vegas, NV 89146-6531
Mailing address
2980 S Rainbow Blvd
Suite 200a
Las Vegas, NV 89146-6531
Phone (702) 315-5670
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1911456000 | Other | OWCP DOL |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY137 | NV | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1351814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351814400000",
"number": "1356695084",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2980 S RAINBOW BLVD",
"address_2": "SUITE 200A",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891466531",
"telephone_number": "702-315-5670",
"fax_number": "702-315-5672"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2980 S RAINBOW BLVD",
"address_2": "SUITE 200A",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891466531",
"telephone_number": "702-315-5670",
"fax_number": "702-315-5672"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "LYNN",
"middle_name": "DALE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-11-02",
"last_updated": "2012-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NV",
"license": "PY137",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OWCP DOL",
"identifier": "1911456000",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.