Provider Demographics
NPI:1619543600
Name:NEELY, LARA ANNE (DBH, MED, LPC)
Entity Type:Individual
Prefix:DR
First Name:LARA
Middle Name:ANNE
Last Name:NEELY
Suffix:
Gender:F
Credentials:DBH, MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8708 TECHNOLOGY FOREST PL STE 125
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-1182
Mailing Address - Country:US
Mailing Address - Phone:281-419-0080
Mailing Address - Fax:
Practice Address - Street 1:8708 TECHNOLOGY FOREST PL STE 125
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-1182
Practice Address - Country:US
Practice Address - Phone:291-419-0080
Practice Address - Fax:936-213-9181
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84996101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional