Provider Demographics
NPI:1881764132
Name:MARSHALL, LARRY (MA,LPC)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1847 WOODHOLLOW DRIVE
Mailing Address - Street 2:APT #202
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043
Mailing Address - Country:US
Mailing Address - Phone:314-535-7911
Mailing Address - Fax:
Practice Address - Street 1:1847 WOODHOLLOW DR
Practice Address - Street 2:APT #202
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-3981
Practice Address - Country:US
Practice Address - Phone:314-535-7911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000944101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional