Provider Demographics
NPI:1386195261
Name:MULLENS, LARA ERIN (M ED)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:ERIN
Last Name:MULLENS
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:ERIN
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:1161 SUNDERLAND LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76134-3732
Mailing Address - Country:US
Mailing Address - Phone:817-929-1957
Mailing Address - Fax:
Practice Address - Street 1:1161 SUNDERLAND LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76134-3732
Practice Address - Country:US
Practice Address - Phone:817-929-1957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health