Provider Demographics
NPI:1396930178
Name:GILBERT, LARRY JACK (LPC, LMFT, LSSP)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:JACK
Last Name:GILBERT
Suffix:
Gender:M
Credentials:LPC, LMFT, LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 GILMER RD STE C
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-3621
Mailing Address - Country:US
Mailing Address - Phone:903-759-7881
Mailing Address - Fax:903-297-9331
Practice Address - Street 1:813 GILMER RD STE C
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-3621
Practice Address - Country:US
Practice Address - Phone:903-759-7881
Practice Address - Fax:903-297-9331
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX754101YM0800X
TX5914101YS0200X
TX113106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist