Provider Demographics
NPI:1669790986
Name:NALLS, LARRY LEE (LPC)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:LEE
Last Name:NALLS
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 1:2990 EARL GOODWIN PKWY
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36703-2860
Mailing Address - Country:US
Mailing Address - Phone:334-418-6527
Mailing Address - Fax:334-875-3145
Practice Address - Street 1:2990 EARL GOODWIN PKWY
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36703-2860
Practice Address - Country:US
Practice Address - Phone:334-418-6527
Practice Address - Fax:334-875-3145
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2368101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL330000021Medicaid