Individual
MR. LARRY WAYNE BREEDLOVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1906 N JUNIATA ST, HOLLIDAYSBURG, PA 16648-1908
(814) 695-2984
(814) 695-2110
Mailing address
1906 N JUNIATA ST, HOLLIDAYSBURG, PA 16648-1908
(814) 695-2984
(814) 695-2110
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
CW023022
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SYC7165
STAFF CODE
CA
Enumeration date
03/08/2007
Last updated
07/28/2023
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