Provider Demographics
NPI:1134501935
Name:LARA, LINA (MS, LPC)
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:LARA
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 SHIELS DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-3550
Mailing Address - Country:US
Mailing Address - Phone:361-902-6627
Mailing Address - Fax:361-881-1484
Practice Address - Street 1:922 SHIELS DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-3550
Practice Address - Country:US
Practice Address - Phone:361-902-6627
Practice Address - Fax:361-881-1484
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70187101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional