Provider Demographics
NPI:1164875779
Name:DOWE, LARISSA (PLMHP, PCMSW)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:DOWE
Suffix:
Gender:F
Credentials:PLMHP, PCMSW
Other - Prefix:
Other - First Name:LARISSA
Other - Middle Name:
Other - Last Name:PEYTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2314 PILGRIM DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-3790
Mailing Address - Country:US
Mailing Address - Phone:320-293-3650
Mailing Address - Fax:
Practice Address - Street 1:11550 I ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1262
Practice Address - Country:US
Practice Address - Phone:402-202-9957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE69921041C0700X
NE105771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical