Provider Demographics
NPI:1548667801
Name:MCCAIN, LARISSA (LMFT)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:MCCAIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 CRESPI DR
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-3512
Mailing Address - Country:US
Mailing Address - Phone:808-692-7714
Mailing Address - Fax:
Practice Address - Street 1:14075 HESPERIA RD STE 101
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4500
Practice Address - Country:US
Practice Address - Phone:760-810-0000
Practice Address - Fax:760-810-0176
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT 409106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist