Active NPI
Polly Kathryn Larson
- Mental Health Counselor
- Carmel, IN
National Provider Identifier
1972119675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 99099767A
- Practice address
- 580 E Carmel Dr
Carmel, IN 46032-3317 - Phone
- (317) 564-8332
- Fax
- (317) 660-2151
- NPI assigned
- Sep 17, 2020
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 99099767A | IN | Primary |
Addresses
Primary practice location
580 E Carmel Dr
Carmel, IN 46032-3317
Mailing address
25 Staten PL
Zionsville, IN 46077-1140
Phone (317) 250-6176
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 |
|---|---|---|---|
| 99099767A | IN | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mustard Seed Center for Growth LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Social Worker
- Carmel, IN
- NPI 1639685571
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600300800000",
"number": "1972119675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 STATEN PL",
"city": "ZIONSVILLE",
"state": "IN",
"postal_code": "460771140",
"telephone_number": "317-250-6176"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "580 E CARMEL DR",
"city": "CARMEL",
"state": "IN",
"postal_code": "460323317",
"telephone_number": "317-564-8332",
"fax_number": "317-660-2151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "POLLY",
"middle_name": "KATHRYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-09-17",
"last_updated": "2020-09-17",
"certification_date": "2020-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IN",
"license": "99099767A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carmel, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.