Provider Demographics
NPI:1871825125
Name:LARRY GALPERT, PHD
Entity Type:Organization
Organization Name:LARRY GALPERT, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GALPERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:805-781-0217
Mailing Address - Street 1:1540 MARSH ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2936
Mailing Address - Country:US
Mailing Address - Phone:805-781-0217
Mailing Address - Fax:
Practice Address - Street 1:1540 MARSH ST
Practice Address - Street 2:SUITE 260
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2936
Practice Address - Country:US
Practice Address - Phone:805-781-0217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21919261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)