Provider Demographics
NPI:1659367282
Name:LARA, MARIA ELENA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIA ELENA
Middle Name:
Last Name:LARA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RIVER VALLEY PSYCHOLOGICAL ASSOCIATES
Mailing Address - Street 2:16040 CHRISTENSEN RD #212
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188
Mailing Address - Country:US
Mailing Address - Phone:206-431-5336
Mailing Address - Fax:206-431-5430
Practice Address - Street 1:RIVER VALLEY PSYCHOLOGICAL ASSOCIATES
Practice Address - Street 2:16040 CHRISTENSEN RD #212
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188
Practice Address - Country:US
Practice Address - Phone:206-431-5336
Practice Address - Fax:206-431-5430
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002389103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist