Provider Demographics
NPI:1649742883
Name:FELIX LARA, GABRIEL MICHAEL (BEHAVIOR ANALYST)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:MICHAEL
Last Name:FELIX LARA
Suffix:
Gender:M
Credentials:BEHAVIOR ANALYST
Other - Prefix:
Other - First Name:GABRIEL
Other - Middle Name:MICHAEL
Other - Last Name:FELIX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:222 N BROCKWAY ST APT 2
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-0423
Mailing Address - Country:US
Mailing Address - Phone:224-443-8505
Mailing Address - Fax:
Practice Address - Street 1:3100 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-3956
Practice Address - Country:US
Practice Address - Phone:708-863-3803
Practice Address - Fax:708-863-3863
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
IL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst