Individual
LARISSA BARCLAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, NP-C, PMHNP-BC
Contact information
Practice address
17515 W 9 MILE RD STE 395, SOUTHFIELD, MI 48075-4400
(248) 963-8189
(763) 402-7611
Mailing address
17515 W 9 MILE RD STE 395, SOUTHFIELD, MI 48075-4400
(248) 963-8189
(763) 402-7611
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704196307
MI
363LA2200X
Adult Health Nurse Practitioner
4704196307
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
4704196307
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5008674420
BCBS
MI
01
—
ON99340003
MEDICARE
MI
Enumeration date
06/07/2007
Last updated
01/09/2026
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