Provider Demographics
NPI:1013551340
Name:LIERA, LOURDES VILLARREAL (SUDPT)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:VILLARREAL
Last Name:LIERA
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 AIRPORT DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-8048
Mailing Address - Country:US
Mailing Address - Phone:360-734-5458
Mailing Address - Fax:360-734-5298
Practice Address - Street 1:3350 AIRPORT DR
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8048
Practice Address - Country:US
Practice Address - Phone:360-734-5458
Practice Address - Fax:360-734-5298
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60965287101YA0400X
WACP61205152101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)