Provider Demographics
NPI:1962250704
Name:SMILEY, LARRY JR
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:SMILEY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 MENTON CT
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-9537
Mailing Address - Country:US
Mailing Address - Phone:209-233-5401
Mailing Address - Fax:
Practice Address - Street 1:1299 YOSEMITE PKWY
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-5265
Practice Address - Country:US
Practice Address - Phone:209-722-6335
Practice Address - Fax:209-722-6371
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty