Basic Information
| Provider Information | |||||||||
| NPI: | 1902484058 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ORR | ||||||||
| FirstName: | LARRY | ||||||||
| MiddleName: | BRET | ||||||||
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| Mailing Information | |||||||||
| Address1: | 365 W 50 N # 8 | ||||||||
| Address2: | |||||||||
| City: | VERNAL | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840782004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357902757 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 365 W 50 N # 8 | ||||||||
| Address2: | |||||||||
| City: | VERNAL | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840782004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357902757 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2021 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 12141758-2506 | UT | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.