Provider Demographics
NPI:1700575594
Name:LARA, LESLIE NATALIE (LPC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:NATALIE
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 1:1415 SEMLINGER RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78220-3530
Mailing Address - Country:US
Mailing Address - Phone:210-980-4787
Mailing Address - Fax:
Practice Address - Street 1:1415 SEMLINGER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78220-3530
Practice Address - Country:US
Practice Address - Phone:210-980-4787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00980200101Y00000X
PAPC016990101Y00000X
DEPC-0011653101Y00000X
TX181583101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor