Provider Demographics
NPI:1750597357
Name:WRIGHT, LARRY DEWAYNE (LPC)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:DEWAYNE
Last Name:WRIGHT
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 1:209 N LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:DONIPHAN
Mailing Address - State:MO
Mailing Address - Zip Code:63935-1631
Mailing Address - Country:US
Mailing Address - Phone:573-996-7054
Mailing Address - Fax:573-996-7052
Practice Address - Street 1:209 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:DONIPHAN
Practice Address - State:MO
Practice Address - Zip Code:63935-1631
Practice Address - Country:US
Practice Address - Phone:573-996-7054
Practice Address - Fax:573-996-7052
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000159346101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2000159346OtherLPC LICENSE NUMBER