Provider Demographics
NPI:1083752554
Name:GEHRES, LARRY DEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:DEAN
Last Name:GEHRES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:18615-7812
Mailing Address - Country:US
Mailing Address - Phone:570-836-6554
Mailing Address - Fax:570-378-3675
Practice Address - Street 1:10 TRIEBLE DR
Practice Address - Street 2:SUITE 3
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-7025
Practice Address - Country:US
Practice Address - Phone:570-836-6554
Practice Address - Fax:570-378-3675
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002829-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA115110Medicare ID - Type Unspecified