Healthcare Provider Details

I. General information

NPI: 1659367282
Provider Name (Legal Business Name): MARIA ELENA LARA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RIVER VALLEY PSYCHOLOGICAL ASSOCIATES 16040 CHRISTENSEN RD #212
TUKWILA WA
98188
US

IV. Provider business mailing address

RIVER VALLEY PSYCHOLOGICAL ASSOCIATES 16040 CHRISTENSEN RD #212
TUKWILA WA
98188
US

V. Phone/Fax

Practice location:
  • Phone: 206-431-5336
  • Fax: 206-431-5430
Mailing address:
  • Phone: 206-431-5336
  • Fax: 206-431-5430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY00002389
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: