Provider Demographics
NPI:1225236607
Name:BROWN, LARRY NEAL (LPC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:NEAL
Last Name:BROWN
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 FAIRGREEN CV
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-8542
Mailing Address - Country:US
Mailing Address - Phone:601-853-0608
Mailing Address - Fax:601-605-4085
Practice Address - Street 1:199 CHARMANT PL
Practice Address - Street 2:SUITE 2
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4358
Practice Address - Country:US
Practice Address - Phone:601-605-4084
Practice Address - Fax:601-605-4085
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0251101YP2500X
MS97-0011106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist