Provider Demographics
NPI:1821035288
Name:TRUZZIE, LARRY KEITH (M ED)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:KEITH
Last Name:TRUZZIE
Suffix:
Gender:M
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:OH
Mailing Address - Zip Code:44408-1042
Mailing Address - Country:US
Mailing Address - Phone:330-482-5593
Mailing Address - Fax:330-482-5593
Practice Address - Street 1:750 E PARK AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408-1448
Practice Address - Country:US
Practice Address - Phone:330-482-3871
Practice Address - Fax:330-482-0133
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH794103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0331564Medicaid
OH0331564Medicaid