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General NPI Number Information
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NPI Number | 1083644835
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Entity Type | Individual
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Provider Name | ROBERT LAURENCE LARK PH.D
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Gender | Male
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8301 FLORENCE AVE STE. 315
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City | DOWNEY
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State | CA
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Zip | 90240-3936
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Country | US
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Telephone | 562-706-5516
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Fax | 909-867-2671
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Provider Business Mailing Address
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Address Line | PO BOX 3074
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City | RUNNING SPRINGS
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State | CA
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Zip | 92382-3074
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Country | US
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Telephone | 562-706-5516
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Fax | 909-867-2671
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT 34340
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License Number State | CA
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