Individual
LARISSA THEISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, LSCSW
Contact information
Practice address
4909 HARKNESS AVE, KANSAS CITY, MO 64136-1326
(816) 916-5001
Mailing address
4909 HARKNESS AVE, KANSAS CITY, MO 64136-1326
(816) 916-5001
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2010039062
MO
Other
Enumeration date
09/19/2023
Last updated
09/19/2023
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