Provider Demographics
NPI:1629729751
Name:UNGEMACH, LARISSA (LPC)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:UNGEMACH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LARISSA
Other - Middle Name:
Other - Last Name:BOLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:22001 FAIRMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4897
Mailing Address - Country:US
Mailing Address - Phone:216-932-2800
Mailing Address - Fax:330-296-6126
Practice Address - Street 1:23600 COMMERCE PARK STE A
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5817
Practice Address - Country:US
Practice Address - Phone:216-399-0201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2304811101Y00000X
172V00000X
OHC2103385TRNE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health