Larry G Provence, M.A., L.P.C.
NPI #1801078027 in Prescott Valley, Arizona
Provider Information
- NPI Number
- 1801078027
- Entity Type
- Individual
- Name
- Larry G Provence, M.A., L.P.C.
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Counselor - Professional
- Credential
- M.A., L.P.C.
- Enumeration Date
- Nov 29, 2007
- Last Updated
- Nov 29, 2007
Practice Location
- Address
- 4715 N STAGE WAY LN
- City
- Prescott Valley
- State
- Arizona
- ZIP Code
- 86314-5325
- Phone
- (928) 775-0019
Specialties & Taxonomy Codes
| Specialty |
|---|
| Counselor - Professional — Professional |
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