Provider Demographics
NPI:1265796817
Name:BARNUM, LARRY (MA, MFT)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:BARNUM
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1721
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89505-1721
Mailing Address - Country:US
Mailing Address - Phone:775-786-1828
Mailing Address - Fax:
Practice Address - Street 1:313 FLINT ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-2005
Practice Address - Country:US
Practice Address - Phone:775-786-1828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV454106H00000X
CA15091106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist