Provider Demographics
NPI:1942582382
Name:HILL, LARRY QUINZALE (BHRS)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:QUINZALE
Last Name:HILL
Suffix:
Gender:M
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8605 NE 20TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73141-2244
Mailing Address - Country:US
Mailing Address - Phone:405-769-8776
Mailing Address - Fax:
Practice Address - Street 1:2601 NW EXPRESSWAY
Practice Address - Street 2:102 E
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7272
Practice Address - Country:US
Practice Address - Phone:405-858-8656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200049041Medicaid