Healthcare Provider Details

I. General information

NPI: 1467012146
Provider Name (Legal Business Name): RACHEL LARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2019
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5136 EAGLE DR RM 102
USAF ACADEMY CO
80840-2607
US

IV. Provider business mailing address

4102 PINION DR STE 100
USAF ACADEMY CO
80840-2502
US

V. Phone/Fax

Practice location:
  • Phone: 719-333-5177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810008180
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: