Basic Information
| Provider Information | |||||||||
| NPI: | 1699443838 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ENGLISH | ||||||||
| FirstName: | LARRY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 631278 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452631278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414850121 | ||||||||
| FaxNumber: | 9414850591 | ||||||||
| Practice Location | |||||||||
| Address1: | 2574 COMMERCE PKWY | ||||||||
| Address2: | |||||||||
| City: | NORTH PORT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342899334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414850121 | ||||||||
| FaxNumber: | 9414850591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2021 | ||||||||
| LastUpdateDate: | 09/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MH15818 | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.