Provider Demographics
NPI:1275905051
Name:SMITH, LARRY JOSEPH JR (NBCC)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:JOSEPH
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 OLD SPANISH TRL
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-2204
Mailing Address - Country:US
Mailing Address - Phone:228-467-8203
Mailing Address - Fax:228-467-8203
Practice Address - Street 1:827 OLD SPANISH TRL
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-2204
Practice Address - Country:US
Practice Address - Phone:228-467-8203
Practice Address - Fax:228-467-8203
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor