Provider Demographics
NPI:1245891258
Name:ANDERS, LARA LISA (MFT)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:LISA
Last Name:ANDERS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 UNITED WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4970
Mailing Address - Country:US
Mailing Address - Phone:541-773-2999
Mailing Address - Fax:541-773-2999
Practice Address - Street 1:1911 UNITED WAY
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4970
Practice Address - Country:US
Practice Address - Phone:541-773-2999
Practice Address - Fax:541-773-2999
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1557106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty