Provider Demographics
NPI:1649598368
Name:LARERY DVALI PSYCHOLOGICAL SERVICES, PC
Entity Type:Organization
Organization Name:LARERY DVALI PSYCHOLOGICAL SERVICES, PC
Other - Org Name:LARERY, NANCE & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL NEUROPSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LARERY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:832-794-7513
Mailing Address - Street 1:7515 MAIN ST
Mailing Address - Street 2:STE. 605
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4519
Mailing Address - Country:US
Mailing Address - Phone:713-796-9946
Mailing Address - Fax:713-796-9873
Practice Address - Street 1:7515 MAIN ST
Practice Address - Street 2:STE. 605
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4519
Practice Address - Country:US
Practice Address - Phone:713-796-9946
Practice Address - Fax:713-796-9873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34051103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty