Individual
LARRY JOE BLUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAC, CHW, MATS, MTH
Contact information
Practice address
8202 CLEARVISTA PKWY, INDIANAPOLIS, IN 46256-1400
(317) 623-3007
(317) 671-7189
Mailing address
8202 CLEARVISTA PKWY, INDIANAPOLIS, IN 46256-1400
(317) 623-3007
(317) 671-7189
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
86000347A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32-0548053
86000347A
IN
Enumeration date
09/14/2020
Last updated
09/14/2020
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