Provider Demographics
NPI:1568560431
Name:BROWN, LARRY D (EDD LMHP)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:D
Last Name:BROWN
Suffix:
Gender:M
Credentials:EDD LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1208
Mailing Address - Street 2:110 NORTH BAILEY
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69103
Mailing Address - Country:US
Mailing Address - Phone:308-534-0440
Mailing Address - Fax:308-534-8775
Practice Address - Street 1:110 NORTH BAILEY
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69103
Practice Address - Country:US
Practice Address - Phone:308-534-6029
Practice Address - Fax:308-534-6961
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE271106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist