Provider Demographics
NPI:1033002605
Name:HIMROD, LARA ELIZABETH
Entity type:Individual
Prefix:MS
First Name:LARA
Middle Name:ELIZABETH
Last Name:HIMROD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:ELIZABETH
Other - Last Name:DURRAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:611 WALNUT STREET
Mailing Address - Street 2:PO BOX 244
Mailing Address - City:MARTINS FERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43935
Mailing Address - Country:US
Mailing Address - Phone:740-609-5072
Mailing Address - Fax:740-609-5073
Practice Address - Street 1:611 WALNUT STREET
Practice Address - Street 2:M
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935
Practice Address - Country:US
Practice Address - Phone:740-609-5072
Practice Address - Fax:740-609-5073
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BCBA12045621103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst