Active NPI
Kelly J Larsen, LCPC
- Professional Counselor
- Wheaton, IL
National Provider Identifier
1497024152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180008049
- Practice address
- 111 N County Farm Rd
Wheaton, IL 60187-3977 - Phone
- (630) 382-7400
- NPI assigned
- Dec 23, 2011
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180008049 | IL | Primary |
Addresses
Primary practice location
111 N County Farm Rd
Wheaton, IL 60187-3977
Mailing address
111 N County Farm Rd
Wheaton, IL 60187-3977
Phone (630) 382-7400
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1324598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1324598400000",
"number": "1497024152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 N COUNTY FARM RD",
"city": "WHEATON",
"state": "IL",
"postal_code": "601873977",
"telephone_number": "630-382-7400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 N COUNTY FARM RD",
"city": "WHEATON",
"state": "IL",
"postal_code": "601873977",
"telephone_number": "630-382-7400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSEN",
"first_name": "KELLY",
"middle_name": "J",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-12-23",
"last_updated": "2011-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180008049",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wheaton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.