Keith David Larsen

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

3239 Independence Rd
Canon City, CO 81212-9380

Phone

(719) 275-7650

NPI assigned

Sep 15, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505433600000",
    "number": "1679092167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3239 INDEPENDENCE RD",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812129380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3239 INDEPENDENCE RD",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812129380",
            "telephone_number": "719-275-7650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "KEITH",
        "middle_name": "DAVID",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-09-15",
        "last_updated": "2017-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tabitha Marie Lane, PA
• James Lantzy, LSW
• Karina Lantzy, LCSW
• James S Lanum, MA MFT LPC
• Brielle M Larsen
• Kerry K Larson, M.D.
• Anil K Lartius
• Kyle J. Lassiter, L.P.C.
• Learning Curve, Inc
• Geraldine M Lee, LCSW

• Peer Specialist in Canon City, CO
• Providers in Canon City, CO by specialty
• Peer Specialist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.