Provider Demographics
NPI:1497813059
Name:KING, LARRY JR
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:KING
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13831 NORTHWEST FWY STE 240
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-5258
Mailing Address - Country:US
Mailing Address - Phone:281-673-0094
Mailing Address - Fax:281-970-7792
Practice Address - Street 1:13831 NORTHWEST FWY STE 240
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-5258
Practice Address - Country:US
Practice Address - Phone:281-673-0094
Practice Address - Fax:281-710-7097
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TM1800X
TX001011485-001009200103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities