Provider Demographics
NPI:1750476636
Name:COURRIER, LARA L (MA)
Entity Type:Individual
Prefix:MRS
First Name:LARA
Middle Name:L
Last Name:COURRIER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 REYNOLDS TER
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-2811
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 CENTER ST
Practice Address - Street 2:MOUNTAIN STATE PSYCHOLOGICAL SERVICES, PLLC
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-3520
Practice Address - Country:US
Practice Address - Phone:304-788-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1806101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional