Provider Demographics
NPI:1053376467
Name:ALLEN, LARRY TODD (LPC)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:TODD
Last Name:ALLEN
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Gender:M
Credentials:LPC
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Mailing Address - Street 1:2725 N WESTWOOD BLVD
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2346
Mailing Address - Country:US
Mailing Address - Phone:573-785-0333
Mailing Address - Fax:573-785-0333
Practice Address - Street 1:2725 N WESTWOOD BLVD
Practice Address - Street 2:SUITE 5A
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2346
Practice Address - Country:US
Practice Address - Phone:573-785-0333
Practice Address - Fax:573-785-0333
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2011-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO002436101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1053376467OtherUNITED HEALTHCARE
MO000000443672OtherANTHEM BLUE CROSS BLUE SHIELD
MO1053376467Medicaid
MO1053376467OtherHEALTHLINK, INC