MEDICARE: LARRY MARSHALL MA,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
1	101YP2500X	Professional Counselor	000944	MO

General Provider Information

NPI Number	:	1881764132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY MARSHALL MA,LPC

Provider Business Mailing Address
First Line	:	1847 WOODHOLLOW DRIVE
Second Line	:	APT #202
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043
Country	:	US
Telephone Number	:	314-535-7911
Fax Number	:

Provider Business Practice Location Address
First Line	:	1847 WOODHOLLOW DR
Second Line	:	APT #202
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-3981
Country	:	US
Telephone Number	:	314-535-7911
Fax Number	:

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2007

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