Provider Demographics
NPI:1649221805
Name:SPRINGATE, LARRY G (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:G
Last Name:SPRINGATE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WIND HAVEN DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-8035
Mailing Address - Country:US
Mailing Address - Phone:859-277-0022
Mailing Address - Fax:859-277-0077
Practice Address - Street 1:101 WIND HAVEN DR
Practice Address - Street 2:SUITE 202
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-8035
Practice Address - Country:US
Practice Address - Phone:859-277-0022
Practice Address - Fax:859-277-0077
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1082103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCPOO190Medicare ID - Type Unspecified