Provider Demographics
NPI:1275324055
Name:LARA, MARIBEL (LPC)
Entity type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:LARA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MARRIOTT DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-2213
Mailing Address - Country:US
Mailing Address - Phone:361-777-3991
Mailing Address - Fax:
Practice Address - Street 1:1010 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ARANSAS PASS
Practice Address - State:TX
Practice Address - Zip Code:78336-5306
Practice Address - Country:US
Practice Address - Phone:361-226-3022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64138101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health