Provider Demographics
NPI:1598942559
Name:WASHINGTON, LARRY GROVER (MS LPC)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:GROVER
Last Name:WASHINGTON
Suffix:
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 1:1801 N HAMPTON RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2391
Mailing Address - Country:US
Mailing Address - Phone:972-298-6600
Mailing Address - Fax:972-298-6731
Practice Address - Street 1:1801 N HAMPTON RD
Practice Address - Street 2:SUITE 340
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2391
Practice Address - Country:US
Practice Address - Phone:972-298-6600
Practice Address - Fax:972-298-6731
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19695101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional