Healthcare Provider Details

I. General information

NPI: 1740345529
Provider Name (Legal Business Name): LARA E. EMBRY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3256 HIGHLAND DR
BIRMINGHAM AL
35205-1451
US

IV. Provider business mailing address

3256 HIGHLAND DR
BIRMINGHAM AL
35205-1451
US

V. Phone/Fax

Practice location:
  • Phone: 205-538-5823
  • Fax:
Mailing address:
  • Phone: 205-538-5823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY 7390
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 7390
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPY 7390
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1899
License Number StateAL
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1899
License Number StateAL
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number1899
License Number StateAL
# 7
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number1899
License Number StateAL
# 8
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number1899
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: