Larissa Briaun Hackett

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

87520 Bay Rd
Christmas Valley, OR 97641-2233

Phone

(541) 947-6021

Fax

(541) 576-3000

NPI assigned

Feb 16, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lake Health District

  dba Lake District Wellness Center

  • Counseling Psychologist
  • Lakeview, OR
  • NPI 1821711177
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644969600000",
    "number": "1811642994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 S G ST",
            "city": "LAKEVIEW",
            "state": "OR",
            "postal_code": "976301817",
            "telephone_number": "541-947-6021",
            "fax_number": "541-219-8114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "87520 BAY RD",
            "city": "CHRISTMAS VALLEY",
            "state": "OR",
            "postal_code": "976412233",
            "telephone_number": "541-947-6021",
            "fax_number": "541-576-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKETT",
        "first_name": "LARISSA",
        "middle_name": "BRIAUN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-16",
        "last_updated": "2022-02-16",
        "certification_date": "2022-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bruce D Carlson M.D.
• Dennis M. Bruneau, PA-C
• Central Cascades Physical Therapy
• Alexandra Day
• Denise Lee Griffiths, FNP
• Shawn Kimberly Lavallee
• Emily Louise Merwin
• Kendra Murphy
• North Lake Clinic LLC (North Lake Clinic)
• North Lake Clinic, LLC

• Student in an Organized Health Care Education/Training Program in Christmas Valley, OR
• Providers in Christmas Valley, OR by specialty
• Student in an Organized Health Care Education/Training Program in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.