Healthcare Provider Details

I. General information

NPI: 1891345286
Provider Name (Legal Business Name): LARA AND ASSOCIATES PLLC COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 SOUTH FIRST AVENUE
YUMA AZ
85364-2264
US

IV. Provider business mailing address

244 SOUTH FIRST AVENUE
YUMA AZ
85364-2264
US

V. Phone/Fax

Practice location:
  • Phone: 928-782-2800
  • Fax: 928-782-9600
Mailing address:
  • Phone: 928-782-2800
  • Fax: 928-782-9600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: IRMA LARA
Title or Position: CEO
Credential: MA
Phone: 928-782-2600