Provider Demographics
NPI:1790551828
Name:HEMLEY, LARISSSA (LMHC)
Entity Type:Individual
Prefix:
First Name:LARISSSA
Middle Name:
Last Name:HEMLEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8264 HIGHWAY 89
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-9048
Mailing Address - Country:US
Mailing Address - Phone:850-449-9340
Mailing Address - Fax:
Practice Address - Street 1:9999 CHEMSTRAND RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-2724
Practice Address - Country:US
Practice Address - Phone:850-471-3430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH23056101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health