| Provider / Organization | NPI | Date Certified |
|---|---|---|
| LARRY PHILLIPS | 1912587304 | 2021-04-10 |
Larry Phillips is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1912587304. Registration indicates Larry Phillips is a provider of services with a specialization in Behavioral Health & Social Service Providers, Behavior Technician (Behavior Technician, Behavioral Health & Social Service Providers) (Behavior Technician, )
| Entity Type | Individual |
| Provider Name | Larry Phillips Iii |
| Practice Office Address | 3207 S 73RD DR PHOENIX, AZ US |
| Practice Office Telephone | 6023140276 |
| Mailing Address | 401 W WESTERN AVE UNIT 345 AVONDALE, AZ 853234414 US |
| Code | Practice | License No State |
|---|---|---|
| 106S00000X PRIMARY | Behavioral Health & Social Service Providers Behavior Technician Behavior Technician Behavioral Health & Social Service Providers Behavior Technician | |
| 193400000X SING | Group Code |