Provider Demographics
NPI:1417553306
Name:HUGHES, LARISSA HELEN
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:HELEN
Last Name:HUGHES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4122 WILLIAMSON LN
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-2237
Mailing Address - Country:US
Mailing Address - Phone:850-723-6570
Mailing Address - Fax:
Practice Address - Street 1:8100 OPPORTUNITY DR
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32583-8727
Practice Address - Country:US
Practice Address - Phone:850-723-6570
Practice Address - Fax:850-994-8443
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-321229106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician