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General NPI Number Information
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NPI Number | 1558156851
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Entity Type | Organization
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Legal Business Name | LARACOUNSELING
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Dates
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Enumeration Date | 04/09/2025
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 4190 S HIGHLAND DR STE 112
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City | MILLCREEK
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State | UT
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Zip | 84124-2669
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Country | US
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Telephone | 385-377-9308
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Fax |
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Provider Business Mailing Address
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Address Line | 6284 S WESTLILAC DR
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City | WEST JORDAN
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State | UT
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Zip | 84081-3857
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Country | US
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Telephone | 561-703-9628
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/ OWNER
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Name | MR. ROBERTO LARA
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Credential | LCSW
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Telephone | 385-377-9308
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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