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General NPI Number Information
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NPI Number | 1134660871
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Entity Type | Individual
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Provider Name | CAROLINA LARA-LERMA MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 03/14/2017
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 4577 W PECOS RD
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City | LAVEEN
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State | AZ
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Zip | 85339-9002
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Country | US
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Telephone | 520-610-5556
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Fax | 520-550-6033
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Provider Business Mailing Address
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Address Line | 26428 W. MC85
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City | BUCKEYE
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State | AZ
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Zip | 85326
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Country | US
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Telephone | 602-245-0516
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-21088
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License Number State | AZ
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