Provider Demographics
NPI:1003048331
Name:BATEMAN, LARISSA J (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:J
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5776 STONERIDGE MALL RD STE 140
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-2833
Mailing Address - Country:US
Mailing Address - Phone:925-605-9662
Mailing Address - Fax:
Practice Address - Street 1:5776 STONERIDGE MALL RD STE 140
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2833
Practice Address - Country:US
Practice Address - Phone:925-605-9662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60975106H00000X
CA83971106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist