Provider Demographics
NPI:1235021866
Name:DEBORD, LARZETTA PEARL (LMHC)
Entity type:Individual
Prefix:
First Name:LARZETTA
Middle Name:PEARL
Last Name:DEBORD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4694 WILKERSON BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:FL
Mailing Address - Zip Code:32564-9606
Mailing Address - Country:US
Mailing Address - Phone:850-758-0631
Mailing Address - Fax:
Practice Address - Street 1:4694 WILKERSON BLUFF RD
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:FL
Practice Address - Zip Code:32564-9606
Practice Address - Country:US
Practice Address - Phone:850-758-0631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16121101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health