Provider Demographics
NPI:1851151021
Name:JONES, LARRY WAYNE JR (LPC, M DIV)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:WAYNE
Last Name:JONES
Suffix:JR
Gender:M
Credentials:LPC, M DIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 80 BOX 13287
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96367-0035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BLDG 439
Practice Address - Street 2:CAMP FOSTER MARINE CORPS BASE
Practice Address - City:KITAMAE
Practice Address - State:CHATAN-CHO OKINAWA
Practice Address - Zip Code:9040117
Practice Address - Country:JP
Practice Address - Phone:315-645-5548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0017371101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional