Individual
MR. LARRY EUGENE SMITH SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC,ICADC
Contact information
Practice address
32208 S. 620 RD, GROVE, OK 74344
(918) 787-7769
(918) 787-7761
Mailing address
PO BOX 451585, GROVE, OK 74345-1585
(918) 787-7769
(918) 787-7761
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
46, 13162
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46,13162
CADC, ICADC
OK
Enumeration date
07/12/2007
Last updated
07/12/2007
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