Individual provider Active NPI

Larissa Catherine Miller, PHD

  • Psychologist
  • Denver, CO
National Provider Identifier
1407453889
Registry record updated Nov 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY.0005675 Issued in CO
Practice address
1001 Yosemite St
Denver, CO 80230-6003
Phone
(303) 602-4545
NPI assigned
Oct 8, 2020
Last updated
Nov 9, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 3260 OR
Psychologist 103T00000X PSY.0005675 CO Primary

Addresses

Primary practice location

1001 Yosemite St
Denver, CO 80230-6003

Mailing address

777 Bannock St # Mc1923
Denver, CO 80204-4597
Phone (303) 436-6000

Other identifiers 1

IdentifierTypeStateIssuer
500786080MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211111001715 CO Practitioner - Clinical Psychologist 6800201716 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Denver Health and Hospital Authority CurrentSince Nov 1, 2021 Accepting new patients
Denver Health and Hospital Authority CurrentSince Nov 1, 2021 Accepting new patients

Locations

777 Bannock St
Denver, CO 80204

777 Bannock St
#1923
Denver, CO 80204
Phone (303) 602-2720

777 Bannock St
#3240
Denver, CO 80204
Phone (303) 602-2714

1001 Yosemite St
Lowry, CO 80230
Phone (303) 436-4545

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": "1602115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636416000000",
    "number": "1407453889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 BANNOCK ST # MC1923",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802044597",
            "telephone_number": "303-436-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 YOSEMITE ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802306003",
            "telephone_number": "303-602-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "LARISSA",
        "middle_name": "CATHERINE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-08",
        "last_updated": "2021-11-09",
        "certification_date": "2021-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OR",
            "license": "3260",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CO",
            "license": "PSY.0005675",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500786080",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.