Provider Demographics
NPI:1285894980
Name:PETRY, HAROLD RAY II (LMHC)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:RAY
Last Name:PETRY
Suffix:II
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13420 DEL PRADO DR S
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-5403
Mailing Address - Country:US
Mailing Address - Phone:727-698-6670
Mailing Address - Fax:
Practice Address - Street 1:1938 SOULE RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1507
Practice Address - Country:US
Practice Address - Phone:727-726-7442
Practice Address - Fax:727-288-1111
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1816101YP2500X
FLMH9052101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1816OtherSTATE LICENSE NUMBER
FLMH9052OtherFLORIDA DEPARTMENT OF HEALTH