Provider Demographics
NPI:1073107702
Name:AMBRIS, MAIRA LARA (RBT)
Entity Type:Individual
Prefix:
First Name:MAIRA
Middle Name:LARA
Last Name:AMBRIS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3335 LT MOSS RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7222
Mailing Address - Country:US
Mailing Address - Phone:406-549-6413
Mailing Address - Fax:406-542-0143
Practice Address - Street 1:3335 LT MOSS RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7222
Practice Address - Country:US
Practice Address - Phone:406-549-6413
Practice Address - Fax:406-542-0143
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-04-21
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician