Provider Demographics
NPI:1639204209
Name:LARA, ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:LARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-3823
Mailing Address - Country:US
Mailing Address - Phone:661-326-1555
Mailing Address - Fax:
Practice Address - Street 1:4520 CALIFORNIA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-1190
Practice Address - Country:US
Practice Address - Phone:661-321-3124
Practice Address - Fax:661-321-3125
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)