Active NPI
Jonathan Matthew Larson, MS
- Clinical Psychologist
- Wichita, KS
National Provider Identifier
1649017914
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 03266
- Practice address
- 100 S Main St Ste 505
Wichita, KS 67202-3738 - Phone
- (316) 688-8390
- NPI assigned
- Jul 12, 2024
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 03266 | KS | Primary |
Addresses
Primary practice location
100 S Main St Ste 505
Wichita, KS 67202-3738
Mailing address
110 N 127TH St E Apt 1231
Wichita, KS 67206-2772
Phone (310) 748-0355
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03266 | KS | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1720742400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1735948800000",
"number": "1649017914",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 N 127TH ST E APT 1231",
"city": "WICHITA",
"state": "KS",
"postal_code": "672062772",
"telephone_number": "310-748-0355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 S MAIN ST STE 505",
"city": "WICHITA",
"state": "KS",
"postal_code": "672023738",
"telephone_number": "316-688-8390"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "JONATHAN",
"middle_name": "MATTHEW",
"credential": "MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-07-12",
"last_updated": "2025-01-04",
"certification_date": "2025-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "KS",
"license": "03266",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wichita, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.