Provider Demographics
NPI:1750457685
Name:LARA-TONEY, DAVID (MFT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LARA-TONEY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:LARA-TONEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:6223 PASEO DE LA PALMA
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-3857
Mailing Address - Country:US
Mailing Address - Phone:760-902-1185
Mailing Address - Fax:267-363-1751
Practice Address - Street 1:72047 DINAH SHORE DR
Practice Address - Street 2:C-4
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1790
Practice Address - Country:US
Practice Address - Phone:760-902-1185
Practice Address - Fax:267-363-1751
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT18983106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMMM00427MMedicare ID - Type Unspecified