| Doctor Name: | MR. LARRY TODD ALLEN |
| NPI Number: | 1053376467 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.P.C. |
| License Number: | 002436 |
| Business Practice Address: | 2725 N Westwood Blvd Suite 5a Poplar Bluff, MO - 639012346 |
| Business Phone Number: | 5737850333 |
| Business Fax Number: | 5737850333 |
| Mailing Address: | 2725 N Westwood Blvd, Suite 5a POPLAR BLUFF |
| State: | MO |
| Postal Code: | 639012346 |
| Phone Number: | 5737850333 |
| Fax Number: | 5737850333 |
| NPI Enumeration Date: | 04/19/2006 |
| NPI Last Update Date: | 05/24/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 002436 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |