Provider Demographics
NPI:1710226022
Name:REID, LARRY LEE JR (BS)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:LEE
Last Name:REID
Suffix:JR
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4324 SE 48TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-2704
Mailing Address - Country:US
Mailing Address - Phone:405-549-8711
Mailing Address - Fax:
Practice Address - Street 1:4324 SE 48TH TER
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-2704
Practice Address - Country:US
Practice Address - Phone:405-549-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health