Provider Demographics
NPI:1477761773
Name:LARRICK, CHESTER J (LPCC)
Entity type:Individual
Prefix:MR
First Name:CHESTER
Middle Name:J
Last Name:LARRICK
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 PALMETTO PL
Mailing Address - Street 2:
Mailing Address - City:BYESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43723-9602
Mailing Address - Country:US
Mailing Address - Phone:740-685-1610
Mailing Address - Fax:740-685-1610
Practice Address - Street 1:108 PALMETTO PL
Practice Address - Street 2:
Practice Address - City:BYESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43723-9602
Practice Address - Country:US
Practice Address - Phone:740-685-1610
Practice Address - Fax:740-685-1610
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0001153101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2314329Medicaid