Healthcare Provider Details

I. General information

NPI: 1730008434
Provider Name (Legal Business Name): CORRYN LARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8308 COURTLAND DR
EL PASO TX
79907-2417
US

IV. Provider business mailing address

8308 COURTLAND DR
EL PASO TX
79907-2417
US

V. Phone/Fax

Practice location:
  • Phone: 915-422-9563
  • Fax:
Mailing address:
  • Phone: 915-422-9563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18437955
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: