Active NPI
Larry Wayne Burns, PH.D.
- Counseling Psychologist
- Stillwater, OK
National Provider Identifier
1568554533
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 775
- Practice address
- 2222 W 12TH Ave
Stillwater, OK 74074-5154 - Phone
- (405) 377-1988
- Fax
- (405) 624-1988
- NPI assigned
- Sep 28, 2006
- 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 |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 775 | OK | Primary |
Addresses
Primary practice location
2222 W 12TH Ave
Stillwater, OK 74074-5154
Mailing address
2222 W 12TH Ave
Stillwater, OK 74074-5154
Phone (405) 377-1988
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070822000829 | OK | Practitioner - Clinical Psychologist | 5496847477 | Practice locations: Stillwatter, OK |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 775 | OK | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1568554533",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2222 W 12TH AVE",
"city": "STILLWATER",
"state": "OK",
"postal_code": "740745154",
"telephone_number": "405-377-1988",
"fax_number": "405-624-1988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2222 W 12TH AVE",
"city": "STILLWATER",
"state": "OK",
"postal_code": "740745154",
"telephone_number": "405-377-1988",
"fax_number": "405-624-1988"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURNS",
"first_name": "LARRY",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-28",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "OK",
"license": "775",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stillwater, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.