Active NPI
Kristin Larson, ED.D.
- Counseling Psychologist
- Galesburg, IL
National Provider Identifier
1811325319
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 071006423
- Practice address
- 940 W Fremont St
Galesburg, IL 61401-2558 - Phone
- (309) 368-9850
- NPI assigned
- Oct 18, 2013
- Sex
- Female
- 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 | 071006423 | IL | Primary |
Addresses
Primary practice location
940 W Fremont St
Galesburg, IL 61401-2558
Mailing address
940 W Fremont St
Galesburg, IL 61401-2558
Phone (309) 368-9850
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071006423 | IL | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1382054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1382054400000",
"number": "1811325319",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "940 W FREMONT ST",
"city": "GALESBURG",
"state": "IL",
"postal_code": "614012558",
"telephone_number": "309-368-9850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "940 W FREMONT ST",
"city": "GALESBURG",
"state": "IL",
"postal_code": "614012558",
"telephone_number": "309-368-9850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "KRISTIN",
"name_prefix": "Dr.",
"credential": "ED.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-10-18",
"last_updated": "2013-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "IL",
"license": "071006423",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Galesburg, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.