Provider Demographics
NPI:1518100080
Name:RILEY, LARA ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LARA
Middle Name:ANN
Last Name:RILEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-1309
Mailing Address - Country:US
Mailing Address - Phone:509-876-2736
Mailing Address - Fax:509-876-2736
Practice Address - Street 1:709 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-1309
Practice Address - Country:US
Practice Address - Phone:509-876-2736
Practice Address - Fax:509-876-2736
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3680103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical