Provider Demographics
NPI:1598754749
Name:LARRY E. SHYERS, PH.D., AND ASSOCIATES, INC
Entity Type:Organization
Organization Name:LARRY E. SHYERS, PH.D., AND ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SHYERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:352-383-2194
Mailing Address - Street 1:3750 LAKE CENTER LOOP
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2211
Mailing Address - Country:US
Mailing Address - Phone:352-383-2194
Mailing Address - Fax:352-383-2193
Practice Address - Street 1:3750 LAKE CENTER LOOP
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2211
Practice Address - Country:US
Practice Address - Phone:352-383-2194
Practice Address - Fax:352-383-2193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 1054101YM0800X
FLMH 7151101YM0800X
FLMH 8094101YM0800X
FLMH 8889101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053098OtherVALUE OPTIONS
FLX1457OtherBLUE CROSS BLUE SHIELD
FLZ118SOtherBLUE CROSS BLUE SHIELD