Healthcare Provider Details

I. General information

NPI: 1942724224
Provider Name (Legal Business Name): LARISSA HUL-GALASEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LARISSA HUL

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 F ST STE C
ARCATA CA
95521-6364
US

IV. Provider business mailing address

665 F ST STE C
ARCATA CA
95521-6364
US

V. Phone/Fax

Practice location:
  • Phone: 707-572-6541
  • Fax:
Mailing address:
  • Phone: 707-572-6541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number126063
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: