Provider Demographics
NPI:1861925166
Name:LARRY, CLAIRISSA (LPCC)
Entity type:Individual
Prefix:
First Name:CLAIRISSA
Middle Name:
Last Name:LARRY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7852 DUCOR AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91304-4550
Mailing Address - Country:US
Mailing Address - Phone:216-256-9936
Mailing Address - Fax:
Practice Address - Street 1:7852 DUCOR AVE
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91304-4550
Practice Address - Country:US
Practice Address - Phone:216-256-9936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14921101YP2500X
CA4955106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional