Provider Demographics
NPI:1083183305
Name:REDMOND, LARRY
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:REDMOND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2664 S HARPER RD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-6723
Mailing Address - Country:US
Mailing Address - Phone:662-287-4055
Mailing Address - Fax:662-287-4114
Practice Address - Street 1:2664 S HARPER RD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-6723
Practice Address - Country:US
Practice Address - Phone:662-287-4055
Practice Address - Fax:662-287-4114
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health