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General NPI Number Information
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NPI Number | 1043172844
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Entity Type | Individual
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Provider Name | LARISSA MCCULLOUGH
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Gender | Female
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 134 KAHLE DR # D104
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City | STATELINE
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State | NV
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Zip | 89449-9807
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Country | US
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Telephone | 530-208-3579
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Fax |
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Provider Business Mailing Address
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Address Line | 5725 S VALLEY VIEW BLVD STE 5, #361584
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City | LAS VEGAS
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State | NV
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Zip | 89118-3122
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Country | US
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Telephone | 530-208-3579
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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