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General NPI Number Information
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NPI Number | 1497946529
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Entity Type | Organization
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Legal Business Name | LARRY SPRINGATE
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/05/2007
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Provider Practice Location Address
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Address Line | 101 WIND HAVEN DR #202
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-8035
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Country | US
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Telephone | 859-277-0022
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Fax | 859-277-0077
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Provider Business Mailing Address
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Address Line | 101 WIND HAVEN DR #202
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-8035
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Country | US
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Telephone | 859-277-0022
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Fax | 859-277-0077
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Authorized Official
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Title or Position | OWNER
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Name | DR. LARRY G SPRINGATE
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Credential | PSYD
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Telephone | 859-277-0022
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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 | 0432
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1082
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License Number State | KY
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