Provider Demographics
NPI:1730455981
Name:VEATCH, LARRY WILLIAM (MS)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:WILLIAM
Last Name:VEATCH
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24732 SW 1ST RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-3223
Mailing Address - Country:US
Mailing Address - Phone:352-359-0071
Mailing Address - Fax:352-474-6175
Practice Address - Street 1:4723 NW 53RD AVE STE B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-4804
Practice Address - Country:US
Practice Address - Phone:352-338-0164
Practice Address - Fax:352-371-1544
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-31
Last Update Date:2012-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2853101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health