Active NPI
Larry George Wooley, PSYD, HSPP
- Clinical Psychologist
- Columbia City, IN
National Provider Identifier
1801879234
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 20041608A
- Practice address
- 119 W Market St
Columbia City, IN 46725-2311 - Phone
- (260) 248-8176
- Fax
- (260) 248-2366
- NPI assigned
- Nov 21, 2005
- Last updated
- Apr 20, 2011
- 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 | 20041608A | IN | Primary |
Addresses
Primary practice location
119 W Market St
Columbia City, IN 46725-2311
Mailing address
850 N Harrison St
Attn: Anne Lawson
Warsaw, IN 46580-3163
Phone (574) 267-7169
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200307900A | Medicaid | IN |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20041608A | IN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132531200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303257600000",
"number": "1801879234",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "850 N HARRISON ST",
"address_2": "ATTN: ANNE LAWSON",
"city": "WARSAW",
"state": "IN",
"postal_code": "465803163",
"telephone_number": "574-267-7169",
"fax_number": "574-268-2377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "119 W MARKET ST",
"city": "COLUMBIA CITY",
"state": "IN",
"postal_code": "467252311",
"telephone_number": "260-248-8176",
"fax_number": "260-248-2366"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOOLEY",
"first_name": "LARRY",
"middle_name": "GEORGE",
"credential": "PSYD, HSPP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-21",
"last_updated": "2011-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IN",
"license": "20041608A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200307900A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia City, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 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.