Doctor Name: | MR. LARRY SHAWN SANDO |
NPI Number: | 1205268356 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MSW |
License Number: | |
Business Practice Address: | 925 State Route V V Kennett, MO - 63857 |
Business Phone Number: | 5738885925 |
Business Fax Number: | 5738889365 |
Mailing Address: | 925 State Route V V, Po Box 71 KENNETT |
State: | MO |
Postal Code: | 63857 |
Phone Number: | 5738885925 |
Fax Number: | 5738889365 |
NPI Enumeration Date: | 07/31/2013 |
NPI Last Update Date: | 07/31/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |