Provider Demographics
NPI:1598113581
Name:LARA, LORI (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:LARA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5217 HUNTERS CIR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-4207
Mailing Address - Country:US
Mailing Address - Phone:325-201-0587
Mailing Address - Fax:325-219-5599
Practice Address - Street 1:1969 INDUSTRIAL BLVD # 252
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-7833
Practice Address - Country:US
Practice Address - Phone:325-201-0587
Practice Address - Fax:325-219-5599
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70208101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional