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General NPI Number Information
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NPI Number | 1629659610
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Entity Type | Organization
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Legal Business Name | LARA WALDENMAIER LLC
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Dates
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Enumeration Date | 04/20/2021
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Last Update Date | 04/20/2021
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Provider Practice Location Address
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Address Line | 5900 SOM CENTER RD STE 12-203
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City | WILLOUGHBY
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State | OH
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Zip | 44094-3086
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Country | US
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Telephone | 440-540-5258
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Fax |
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Provider Business Mailing Address
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Address Line | 5900 SOM CENTER RD STE 12-203
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City | WILLOUGHBY
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State | OH
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Zip | 44094-3086
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Country | US
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Telephone | 440-540-5258
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Fax |
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Authorized Official
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Title or Position | PROFESSIONAL CLINICAL COUNSELOR
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Name | MRS. LARA WALDENMAIER
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Credential | MA, LPCC
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Telephone | 440-525-6825
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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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