Provider Demographics
NPI:1225193204
Name:PARTIN, LARRY GLEN (LPC)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:GLEN
Last Name:PARTIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5713 GUADALAJARA DR
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-6123
Mailing Address - Country:US
Mailing Address - Phone:469-831-9261
Mailing Address - Fax:
Practice Address - Street 1:320 WESTWAY PL
Practice Address - Street 2:STE 320
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-5245
Practice Address - Country:US
Practice Address - Phone:816-516-9100
Practice Address - Fax:817-516-9102
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19117101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182575401Medicaid