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General NPI Number Information
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NPI Number | 1275324055
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Entity Type | Individual
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Provider Name | MARIBEL LARA LPC
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Gender | Female
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 1010 S COMMERCIAL ST
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City | ARANSAS PASS
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State | TX
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Zip | 78336-5306
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Country | US
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Telephone | 361-226-3022
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Fax |
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Provider Business Mailing Address
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Address Line | 200 MARRIOTT DR
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City | PORTLAND
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State | TX
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Zip | 78374-2213
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Country | US
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Telephone | 361-777-3991
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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 | 64138
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License Number State | TX
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