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NPI Code Detail

MEDICARE: MR. LARRY ROSS CANTRELL LPC

MEDICARE: MR. LARRY ROSS CANTRELL LPC
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
1101YP2500XProfessional CounselorP0907047AR

General Provider Information

NPI Number : 1477693968
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LARRY ROSS CANTRELL LPC
Provider Business Mailing Address
First Line : PO BOX 23070
Second Line :
City : BARLING
State : AR
Zip : 72923-0070
Country : US
Telephone Number : 479-452-5040
Fax Number : 479-452-5047
Provider Business Practice Location Address
First Line : 1340 S WALDRON RD
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-2556
Country : US
Telephone Number : 479-452-5040
Fax Number : 479-452-5047
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2007
Last Update Date : 07/09/2014

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Directions to “ MR. LARRY ROSS CANTRELL LPC” Practice Location

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