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General NPI Number Information
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NPI Number | 1164655247
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Entity Type | Individual
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Provider Name | HECTOR LARA M.S.W.
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Gender | Male
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Dates
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Enumeration Date | 08/24/2009
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Last Update Date | 08/14/2012
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Provider Practice Location Address
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Address Line | 14130 LAKESHORE DR.
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City | CLEARLAKE
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State | CA
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Zip | 95422
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Country | US
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Telephone | 707-272-8707
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Fax | 707-995-1847
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Provider Business Mailing Address
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Address Line | 16170 MAIN STREET
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City | LOWER LAKE
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State | CA
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Zip | 95457
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Country | US
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Telephone | 707-272-8707
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Fax | 707-995-1847
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 29325
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 29325
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License Number State | CA
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