Provider Demographics
NPI:1043527823
Name:MCCALLISTER, LARRY (MA,LPC)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:MCCALLISTER
Suffix:
Gender:M
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5116 N PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2077
Mailing Address - Country:US
Mailing Address - Phone:405-556-0912
Mailing Address - Fax:
Practice Address - Street 1:5116 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2077
Practice Address - Country:US
Practice Address - Phone:405-556-0912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor