Active NPI
Larry L Mullins, PHD
- Psychologist
- Oklahoma City, OK
National Provider Identifier
1760450969
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 439
- Practice address
- 940 NE 13TH St
MRI 3000
Oklahoma City, OK 73104-5008 - Phone
- (405) 271-4412
- NPI assigned
- Mar 14, 2006
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 439 | OK | Primary |
Addresses
Primary practice location
940 NE 13TH St
MRI 3000
Oklahoma City, OK 73104-5008
Mailing address
1122 NE 13TH St
Ori236
Oklahoma City, OK 73117-1039
Phone (405) 271-1515
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140606000262 | OK | Practitioner - Psychologist Billing Independently | 2961468111 | Practice locations: Edmond, OK |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 439 | OK | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1760450969",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1122 NE 13TH ST",
"address_2": "ORI236",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731171039",
"telephone_number": "405-271-1515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "940 NE 13TH ST",
"address_2": "MRI 3000",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731045008",
"telephone_number": "405-271-4412"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLINS",
"first_name": "LARRY",
"middle_name": "L",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OK",
"license": "439",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.