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General NPI Number Information
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NPI Number | 1326257767
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Entity Type | Individual
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Provider Name | WALTER BRYCE LARAWAY M.S.
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Gender | Male
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 12/07/2025
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Provider Practice Location Address
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Address Line | 114 W. VOORHIS AVE
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City | DELAND
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State | FL
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Zip | 32720
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Country | US
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Telephone | 386-801-5357
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Fax |
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Provider Business Mailing Address
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Address Line | 805 N.SUMMIT AVE. P.O.BOX 1000
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City | LAKE HELEN
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State | FL
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Zip | 32744
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Country | US
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Telephone | 386-801-5357
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT 2205
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License Number State | FL
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