Provider Demographics
NPI:1851492706
Name:COY, LARRY DEAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:DEAN
Last Name:COY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 CUSTER DR
Mailing Address - Street 2:STE 203
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4010
Mailing Address - Country:US
Mailing Address - Phone:859-271-7788
Mailing Address - Fax:859-273-3306
Practice Address - Street 1:3150 CUSTER DR
Practice Address - Street 2:STE 203
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4010
Practice Address - Country:US
Practice Address - Phone:859-271-7788
Practice Address - Fax:859-273-3306
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY624104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker