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NPI Code Detail

MEDICARE: LARRY GEORGE WOOLEY PSYD, HSPP

MEDICARE: LARRY GEORGE WOOLEY PSYD, HSPP
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
1103TC0700XClinical Psychologist20041608AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1801879234
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARRY GEORGE WOOLEY PSYD, HSPP
Provider Business Mailing Address
First Line : 850 N HARRISON ST
Second Line : ATTN: ANNE LAWSON
City : WARSAW
State : IN
Zip : 46580-3163
Country : US
Telephone Number : 574-267-7169
Fax Number : 574-268-2377
Provider Business Practice Location Address
First Line : 119 W MARKET ST
Second Line :
City : COLUMBIA CITY
State : IN
Zip : 46725-2311
Country : US
Telephone Number : 260-248-8176
Fax Number : 260-248-2366
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2005
Last Update Date : 04/20/2011

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