Provider Demographics
NPI:1245012160
Name:LARGEN, LARRY DAVID JR
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:DAVID
Last Name:LARGEN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8152 LEGER DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-4742
Mailing Address - Country:US
Mailing Address - Phone:702-872-5382
Mailing Address - Fax:
Practice Address - Street 1:1200 HARRIS SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89124-9215
Practice Address - Country:US
Practice Address - Phone:702-872-5382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV07589-1101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)