Provider Demographics
NPI:1699435172
Name:DURAN, LARISSA ELIZABETH (MS, RMHC-I)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:ELIZABETH
Last Name:DURAN
Suffix:
Gender:F
Credentials:MS, RMHC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9216 SW 213TH LN
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-7300
Mailing Address - Country:US
Mailing Address - Phone:786-717-1424
Mailing Address - Fax:
Practice Address - Street 1:18901 SW 106TH AVE STE 213
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7664
Practice Address - Country:US
Practice Address - Phone:786-732-0071
Practice Address - Fax:305-964-5435
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH21606101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health