Provider Demographics
NPI:1730198987
Name:KELTZ, LARRY MELVIN (LPC, LCDC, LSOTP)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:MELVIN
Last Name:KELTZ
Suffix:
Gender:M
Credentials:LPC, LCDC, LSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 997
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79073-0997
Mailing Address - Country:US
Mailing Address - Phone:806-292-9321
Mailing Address - Fax:806-293-1267
Practice Address - Street 1:3109 OLTON RD
Practice Address - Street 2:105 E
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-6763
Practice Address - Country:US
Practice Address - Phone:806-292-9321
Practice Address - Fax:806-293-1267
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4500101YA0400X
TX10891101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional