Individual
LARRY CARL TUSTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BA, CADC
Contact information
Practice address
501 DEWEY AVE, POTEAU, OK 74953-4215
(918) 649-5035
Mailing address
PO BOX 504, POTEAU, OK 74953-0504
(918) 649-5035
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
OK
Other
Enumeration date
05/28/2010
Last updated
05/28/2010
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