Individual
LARRY R NUSSBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSCSW
Contact information
Practice address
547 N ROOSEVELT ST, WICHITA, KS 67208-3273
(316) 641-4925
(316) 684-5448
Mailing address
57950 LEAVENWORTH ST, MCCONNELL AFB, KS 67221-3506
(316) 759-5864
(316) 759-5038
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0858
KS
Other
Enumeration date
12/28/2005
Last updated
07/08/2007
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