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General NPI Number Information
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NPI Number | 1013262906
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Entity Type | Organization
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Legal Business Name | LARA WEYLAND, PH.D., CLINICAL PSYCHOLOGY, INC.
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 07/31/2012
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Provider Practice Location Address
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Address Line | 2220 MOUNTAIN BLVD SUITE 240
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City | OAKLAND
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State | CA
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Zip | 94611-2958
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Country | US
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Telephone | 510-531-5354
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Fax | 510-222-3508
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Provider Business Mailing Address
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Address Line | 2220 MOUNTAIN BLVD SUITE 240
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City | OAKLAND
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State | CA
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Zip | 94611-2958
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Country | US
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Telephone | 510-531-5354
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Fax | 510-222-3508
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | DR. LARA ADELINE WEYLAND
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Credential | PH.D.
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Telephone | 510-534-5354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY14852
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License Number State | CA
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