MEDICARE: LARRY HAYGOOD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	0133004904	VA

General Provider Information

NPI Number	:	1144982885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY HAYGOOD

Provider Business Mailing Address
First Line	:	9789 PHAIR WAY
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20110-7859
Country	:	US
Telephone Number	:	571-535-2344
Fax Number	:

Provider Business Practice Location Address
First Line	:	9789 PHAIR WAY
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20110-7859
Country	:	US
Telephone Number	:	571-535-2344
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2021
Last Update Date	:	03/03/2026

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Directions to “ LARRY HAYGOOD ” Practice Location

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