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NPI Code Detail

MEDICARE: MRS. LARA L COURRIER M.A.

MEDICARE: MRS. LARA L COURRIER M.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor1806WV

General Provider Information

NPI Number : 1750476636
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LARA L COURRIER M.A.
Provider Business Mailing Address
First Line : 520 REYNOLDS TER
Second Line :
City : KEYSER
State : WV
Zip : 26726-2811
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 130 CENTER ST
Second Line : MOUNTAIN STATE PSYCHOLOGICAL SERVICES, PLLC
City : KEYSER
State : WV
Zip : 26726-3520
Country : US
Telephone Number : 304-788-1113
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 07/08/2007

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