MEDICARE: MICHELLE LARA-CANLAS M.S., LPCC

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
1	101YM0800X	Mental Health Counselor	11339	CA

General Provider Information

NPI Number	:	1811626062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LARA-CANLAS M.S., LPCC

Provider Business Mailing Address
First Line	:	5173 WARING RD STE 515
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-2705
Country	:	US
Telephone Number	:	619-259-0249
Fax Number	:

Provider Business Practice Location Address
First Line	:	5173 WARING RD STE 515
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-2705
Country	:	US
Telephone Number	:	619-259-0249
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2022
Last Update Date	:	07/16/2023

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