Provider Demographics
NPI:1992579379
Name:GARR, KARISSA (LCSW)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:GARR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KARISSA
Other - Middle Name:
Other - Last Name:MANWARING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10861 POWER HIKE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-8120
Mailing Address - Country:US
Mailing Address - Phone:480-518-6286
Mailing Address - Fax:
Practice Address - Street 1:8080 W SAHARA AVE STE D
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1976
Practice Address - Country:US
Practice Address - Phone:702-258-5855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6583-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical