Provider Demographics
NPI:1447337712
Name:KIRKLAND, LARRY M (LMHC)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:M
Last Name:KIRKLAND
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4435 MARION ST
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32448-4630
Mailing Address - Country:US
Mailing Address - Phone:850-323-1002
Mailing Address - Fax:850-482-0015
Practice Address - Street 1:4435 MARION ST
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32448-4630
Practice Address - Country:US
Practice Address - Phone:850-323-1002
Practice Address - Fax:850-482-0015
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8715101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ117COtherBCBS OF FL
FL593745560OtherCOMMERCIAL INSURANCE
FL593745560OtherGROUP TAX ID