Provider Demographics
NPI:1255983862
Name:PRENTICE, LARRY ODELE (MS, LPC, NCC)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:ODELE
Last Name:PRENTICE
Suffix:
Gender:M
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CENTURY PARK S STE 116
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35226-3928
Mailing Address - Country:US
Mailing Address - Phone:256-822-4784
Mailing Address - Fax:
Practice Address - Street 1:2205 BELTLINE RD SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3617
Practice Address - Country:US
Practice Address - Phone:256-973-4134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-13
Last Update Date:2025-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLPC05198101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional