Provider Demographics
NPI:1962560938
Name:GARRETT, LARRY (LPC)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:GARRETT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2023
Mailing Address - Street 2:102 D FM 1098
Mailing Address - City:PRAIRIE VIEW
Mailing Address - State:TX
Mailing Address - Zip Code:77446-2023
Mailing Address - Country:US
Mailing Address - Phone:281-256-6496
Mailing Address - Fax:
Practice Address - Street 1:16311 E AMBER WILLOW TRL
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-5996
Practice Address - Country:US
Practice Address - Phone:281-256-6496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13744101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095684902Medicaid