Provider Demographics
NPI:1497170880
Name:SCHWARTZ, LARA (MA LMFT)
Entity Type:Individual
Prefix:MS
First Name:LARA
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 NW FRANKLIN AVE STE 100A
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-2752
Mailing Address - Country:US
Mailing Address - Phone:541-410-5343
Mailing Address - Fax:
Practice Address - Street 1:731 NW FRANKLIN AVE STE 100A
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2752
Practice Address - Country:US
Practice Address - Phone:541-410-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0915106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist