Provider Demographics
NPI:1609553684
Name:LEISS, LARISSA MICHELLE (LMSW)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:MICHELLE
Last Name:LEISS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 BENTLEY DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-2847
Mailing Address - Country:US
Mailing Address - Phone:775-240-4538
Mailing Address - Fax:
Practice Address - Street 1:5540 RENO CORPORATE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2599
Practice Address - Country:US
Practice Address - Phone:775-448-9760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10772-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker