Doctor Name: | MRS. LARISSA CLARE MINCH |
NPI Number: | 1780826164 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | PC005093 |
Business Practice Address: | 1419 Sandstone Dr Tarentum, PA - 150842649 |
Business Phone Number: | 7249949478 |
Business Fax Number: | |
Mailing Address: | 1419 Sandstone Dr, TARENTUM |
State: | PA |
Postal Code: | 150842649 |
Phone Number: | 7249949478 |
Fax Number: | |
NPI Enumeration Date: | 03/31/2009 |
NPI Last Update Date: | 03/31/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | PC005093 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |