Provider Demographics
NPI:1982264925
Name:PASUT, LARISSA (LMFT)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:PASUT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LARISSA
Other - Middle Name:
Other - Last Name:FELLENZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:612 VALENCIA RD
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-9761
Mailing Address - Country:US
Mailing Address - Phone:408-375-7582
Mailing Address - Fax:
Practice Address - Street 1:901 CAMPISI WAY
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2339
Practice Address - Country:US
Practice Address - Phone:408-337-2889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103871106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist