Individual provider Active NPI

Kevin Duane Larry, LMSW, LCSW

  • Social Worker
  • Grand Blanc, MI
National Provider Identifier
1396932281
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
6801061643 Issued in MI
Practice address
617 Boutell Dr
Grand Blanc, MI 48439-1535
Phone
(404) 988-7120
NPI assigned
Sep 25, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 16, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X CSW003802 GA
Clinical Social Worker 1041C0700X 6801061643 MI
Clinical Social Worker 1041C0700X CSW003802 GA
Social Worker 104100000X 6801061643 MI Primary

Addresses

Primary practice location

617 Boutell Dr
Grand Blanc, MI 48439-1535

Mailing address

617 Boutell Dr
Grand Blanc, MI 48439-1535
Phone (404) 988-7120

Other practice location 1

1102 S. Mackin Rd
Flint, MI 48503-1204
Phone (404) 988-7120

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Key Essentials Counseling and Consulting LLC Current Accepting new patients

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, 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": "1190678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747353600000",
    "number": "1396932281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 BOUTELL DR",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484391535",
            "telephone_number": "404-988-7120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 BOUTELL DR",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484391535",
            "telephone_number": "404-988-7120"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1102 S. Mackin Rd",
            "address_purpose": "LOCATION",
            "city": "Flint",
            "state": "MI",
            "postal_code": "485031204",
            "country_code": "US",
            "telephone_number": "404-988-7120",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LARRY",
        "first_name": "KEVIN",
        "middle_name": "DUANE",
        "name_prefix": "Mr.",
        "credential": "LMSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-25",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "CSW003802",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801061643",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW003802",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801061643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Blanc, MI

Sources for this page

Verify at the official NPI Registry.