Provider Demographics
NPI:1841821279
Name:ABOUNAYAN, LARA
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:ABOUNAYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17761 SIDWELL ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-1029
Mailing Address - Country:US
Mailing Address - Phone:818-621-2252
Mailing Address - Fax:
Practice Address - Street 1:17761 SIDWELL ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-1029
Practice Address - Country:US
Practice Address - Phone:818-621-2252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA128379101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health