Larry Alexander Clemons, CDCA

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

000844 Issued in OH

Practice address

2775 State Route 39
Shelby, OH 44875-9466

Phone

(419) 747-3322

NPI assigned

Apr 25, 2018

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

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cornell Abraxas Group, LLC

  • Children's Substance Abuse Rehabilitation Facility
  • Shelby, OH
  • NPI 1134385669
  NPD (past)
• Cornell Abraxas Group, LLC

  • Children's Substance Abuse Rehabilitation Facility
  • Shelby, OH
  • NPI 1376518902
  NPD (past)

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

{
    "created_epoch": "1524614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524614400000",
    "number": "1962990903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5217 WINSOME WAY",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432202692",
            "telephone_number": "419-571-0011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2775 STATE ROUTE 39",
            "city": "SHELBY",
            "state": "OH",
            "postal_code": "448759466",
            "telephone_number": "419-747-3322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMONS",
        "first_name": "LARRY",
        "middle_name": "ALEXANDER",
        "credential": "CDCA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-25",
        "last_updated": "2018-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "000844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Carter, LSW
• Dakota Castle
• Ajay Chawla, MD
• City of Shelby
• Lannette A Clemons, PA
• Amy Beth Close, LSW, LCDC III
• Keshawn Cobb
• Tremarous Cobb
• Alexander Cole
• Brandon Collins

• All providers in Shelby, OH
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2018; 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.