Active NPI
Larissa Davis Beller, LCSW
- Clinical Social Worker
- Corbin, KY
National Provider Identifier
1467672733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 259920
- Practice address
- 37 South Park Dr. Ste 4
Corbin, KY 40701 - Phone
- (859) 795-1323
- NPI assigned
- Apr 27, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2010-53 | KY | |
| Clinical Social Worker | 1041C0700X | 259920 | KY | Primary |
| Mental Health Counselor | 101YM0800X |
Addresses
Primary practice location
37 South Park Dr. Ste 4
Corbin, KY 40701
Mailing address
37 South Park Dr. Ste, 4
Corbin, KY 40701-0423
Phone (859) 795-1323
Other names 1
- Larissa Davis Roark
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 |
|---|---|---|---|
| 2010-53 | KY | MD | Psychologist |
| 259920 | KY | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bluegrass Behavioral Health Group, LLC | Mental Health | Past | Accepting new patients |
| Sozo Wellness Center | Mental Health | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Mental Health Counselor
- Bimble, KY
- NPI 1700178456
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1734652800000",
"number": "1467672733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "37 SOUTH PARK DR. STE, 4",
"city": "CORBIN",
"state": "KY",
"postal_code": "407010423",
"telephone_number": "859-795-1323"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "37 SOUTH PARK DR. STE 4",
"city": "CORBIN",
"state": "KY",
"postal_code": "40701",
"telephone_number": "859-795-1323"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BELLER",
"first_name": "LARISSA",
"middle_name": "DAVIS",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-27",
"last_updated": "2024-12-20",
"certification_date": "2024-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "KY",
"license": "2010-53",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "KY",
"license": "259920",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "LARISSA",
"last_name": "ROARK",
"middle_name": "DAVIS",
"credential": "LPA",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Corbin, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.