Provence, Larry G
Provence, Larry G is an sole proprietor health care provider with primary practice located at 4715 N Stage Way Ln , Prescott Valley AZ 86314-5325. He recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as his primary health care specialty. Provence, Larry G can be contacted via phone (928) 775-0019.Contact Information
Primary practice address
4715 N Stage Way Ln
Prescott Valley AZ 86314-5325
Phone: (928) 775-0019
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | LPC11598 | Arizona |
Profile Details
| NPI number | 1801078027 |
|---|---|
| LBN Legal business name | Provence, Larry G |
| Credentials | M.A., L.P.C. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 29th, 2007 |
| Last updated | Nov 29th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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