Provider Demographics
NPI:1508992785
Name:ANDREWS, LARRY J (PHD, LPC)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:J
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 JOHN WAYNE LN
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-9469
Mailing Address - Country:US
Mailing Address - Phone:307-272-8880
Mailing Address - Fax:
Practice Address - Street 1:1102 BECK AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3624
Practice Address - Country:US
Practice Address - Phone:307-587-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC352101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
303854OtherBCBS PROV #