Provider Demographics
NPI:1437926037
Name:BOLDING, LARRY JR (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:BOLDING
Suffix:JR
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3122 RUIDOSA AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-2388
Mailing Address - Country:US
Mailing Address - Phone:214-608-6443
Mailing Address - Fax:
Practice Address - Street 1:517 N CARRIER PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5484
Practice Address - Country:US
Practice Address - Phone:214-677-0471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83962101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty