Provider Demographics
NPI:1265566400
Name:GRANT, LARRY L (LPC)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:L
Last Name:GRANT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 GRISHAM RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL
Mailing Address - State:AR
Mailing Address - Zip Code:71968-9563
Mailing Address - Country:US
Mailing Address - Phone:501-282-2750
Mailing Address - Fax:
Practice Address - Street 1:141 GRISHAM RD
Practice Address - Street 2:
Practice Address - City:ROYAL
Practice Address - State:AR
Practice Address - Zip Code:71968-9563
Practice Address - Country:US
Practice Address - Phone:501-282-2750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0607039101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional