Provider Demographics
NPI:1407183577
Name:KRICK, LARA ROCHELLE (MA)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:ROCHELLE
Last Name:KRICK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:ROCHELLE
Other - Last Name:REISHUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37 HARMONY
Mailing Address - Street 2:
Mailing Address - City:TROUT CREEK
Mailing Address - State:MT
Mailing Address - Zip Code:59874-9693
Mailing Address - Country:US
Mailing Address - Phone:406-827-0220
Mailing Address - Fax:
Practice Address - Street 1:1119 MAIDEN LANE
Practice Address - Street 2:
Practice Address - City:THOMPSON FALLS
Practice Address - State:MT
Practice Address - Zip Code:59873
Practice Address - Country:US
Practice Address - Phone:406-827-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1454101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional