| Doctor Name: | DR. LISA KIMBERLY LARGO-MARSH |
| NPI Number: | 1023003340 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 6301008181 |
| Business Practice Address: | 8799 Gull Road Suite 1 Richland, MI - 49083 |
| Business Phone Number: | 2696292207 |
| Business Fax Number: | 2697312324 |
| Mailing Address: | 8799 Gull Rd, Suite 1 RICHLAND |
| State: | MI |
| Postal Code: | 490839100 |
| Phone Number: | 2696292207 |
| Fax Number: | 2696292207 |
| NPI Enumeration Date: | 09/13/2005 |
| NPI Last Update Date: | 08/01/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 6301008181 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |