Provider Demographics
NPI:1316378201
Name:LARRY C. PHINNEY, LICENSED PROFESSIONAL COUNSELING, LLC
Entity Type:Organization
Organization Name:LARRY C. PHINNEY, LICENSED PROFESSIONAL COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PHINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:985-320-0237
Mailing Address - Street 1:30270 JERICHO DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:LA
Mailing Address - Zip Code:70711-2818
Mailing Address - Country:US
Mailing Address - Phone:985-320-0237
Mailing Address - Fax:
Practice Address - Street 1:40521 PUMPKIN CENTER RD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1835
Practice Address - Country:US
Practice Address - Phone:985-320-0237
Practice Address - Fax:225-294-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2937101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty