Provider Demographics
NPI:1811345580
Name:MEADE, LARRY (CDPC, CCC)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:MEADE
Suffix:
Gender:M
Credentials:CDPC, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:1752 STATE HWY 508
Mailing Address - City:ONALASKA
Mailing Address - State:WA
Mailing Address - Zip Code:98570-0485
Mailing Address - Country:US
Mailing Address - Phone:360-978-4186
Mailing Address - Fax:360-978-4926
Practice Address - Street 1:1752 STATE HWY 508
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WA
Practice Address - Zip Code:98570-0485
Practice Address - Country:US
Practice Address - Phone:360-978-4186
Practice Address - Fax:360-978-4926
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00005297101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1996016Medicaid