Provider Demographics
NPI:1124216809
Name:TOWNSLEY, LARRY SHAWN (LMFT)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:SHAWN
Last Name:TOWNSLEY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 MARTINGALE DR
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-2994
Mailing Address - Country:US
Mailing Address - Phone:928-530-2472
Mailing Address - Fax:928-753-5735
Practice Address - Street 1:2040 GOLDEN GATE AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4627
Practice Address - Country:US
Practice Address - Phone:928-530-2472
Practice Address - Fax:928-753-5735
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2008-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-0442106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist