Most Relevant Information
Provider Data
| NPI Number: | 1003433780 |
| Provider Name: | LARISSA ROXANE KENT |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/29/2020 |
| Last Updated: | 06/29/2020 |
Provider Practice Location
3120 OLD FAITHFUL RD STE 100
CHEYENNE
WY
820015890
Practice Location Phone/Fax
| Phone: | 3073691410 |
| Fax: |
Provider Mailing Location
3120 OLD FAITHFUL RD STE 100
CHEYENNE
WY
820015890
Provider Mailing Phone/Fax
| Phone: | 3073658946 |
| Fax: |