Healthcare Provider Details

I. General information

NPI: 1619046034
Provider Name (Legal Business Name): LARRY SCOTT CONNER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAKELAND REGIONAL HOSPITAL 440 SOUTH MARKET
SPRINGFIELD MO
65806-2026
US

IV. Provider business mailing address

5326 SOUTH FORT
SPRINGFIELD MO
65810
US

V. Phone/Fax

Practice location:
  • Phone: 417-865-5581
  • Fax:
Mailing address:
  • Phone: 417-818-2189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2002019886
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: