Individual
MR. LARRY DALE SQUIRES
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
308 MEDIC WAY, GREENCASTLE, IN 46135-2296
(765) 653-2669
(765) 653-8671
Mailing address
9501 W WOLF MOUNTAIN RD, GOSPORT, IN 47433-9597
(812) 876-4151
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34001063A
IN
Other
Enumeration date
05/17/2006
Last updated
07/08/2007
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