Individual
LARISSA FERNE ARCHULETA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
962 CHAMBERS ST STE 11, SOUTH OGDEN, UT 84403-5092
(801) 625-3700
Mailing address
3862 S 2915 W, WEST HAVEN, UT 84401-9865
(801) 678-3291
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7756352-3501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260022408
RAILROAD MEDICARE
UT
05
—
876000308007
—
UT
Enumeration date
08/30/2013
Last updated
01/17/2023
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