Individual
LARRY KEITH CROCOMBE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
B.A.CACII
Contact information
Practice address
509 E 13TH ST, PUEBLO, CO 81001-2940
(719) 546-6666
(719) 543-7764
Mailing address
2561 ELMWOOD LN, PUEBLO, CO 81005-2703
(719) 564-4847
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
4136
CO
Other
Enumeration date
05/29/2007
Last updated
07/08/2007
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