Provider Demographics
NPI:1639352065
Name:MCHUGH, LARISA G (MA, MT-BC)
Entity type:Individual
Prefix:
First Name:LARISA
Middle Name:G
Last Name:MCHUGH
Suffix:
Gender:F
Credentials:MA, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 CORONADO DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-5710
Mailing Address - Country:US
Mailing Address - Phone:937-878-0231
Mailing Address - Fax:
Practice Address - Street 1:439 CORONADO DR
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-5710
Practice Address - Country:US
Practice Address - Phone:937-878-0231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist