Provider Demographics
NPI:1629396239
Name:ASHBAUGH, LARA LEE (LPC)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:LEE
Last Name:ASHBAUGH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:LEE
Other - Last Name:PACKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:7900 LEES SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64139-1246
Mailing Address - Country:US
Mailing Address - Phone:816-404-5322
Mailing Address - Fax:816-404-7225
Practice Address - Street 1:300 W 19TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2026
Practice Address - Country:US
Practice Address - Phone:816-404-5709
Practice Address - Fax:816-404-6024
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007035135101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO494170004Medicaid