Provider Demographics
NPI:1770372187
Name:SNOW, LARRY (LCSW)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:SNOW
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MATAMOROS ST
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-4473
Mailing Address - Country:US
Mailing Address - Phone:205-737-5666
Mailing Address - Fax:205-737-5666
Practice Address - Street 1:115 MATAMOROS ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-4473
Practice Address - Country:US
Practice Address - Phone:205-737-5666
Practice Address - Fax:205-737-5666
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1052681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical