Provider Demographics
NPI:1811869712
Name:LARKEY, ALAZAI BRIANN
Entity type:Individual
Prefix:
First Name:ALAZAI
Middle Name:BRIANN
Last Name:LARKEY
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 E 1100 N
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:IN
Mailing Address - Zip Code:46783-9425
Mailing Address - Country:US
Mailing Address - Phone:260-530-6632
Mailing Address - Fax:
Practice Address - Street 1:653 E 1100 N
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:IN
Practice Address - Zip Code:46783-9425
Practice Address - Country:US
Practice Address - Phone:260-530-6632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN6670038042106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician