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General NPI Number Information
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NPI Number | 1942589684
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Entity Type | Organization
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Legal Business Name | LARA HASTINGS PSYD PA
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Dates
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Enumeration Date | 08/11/2011
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Last Update Date | 09/06/2011
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Provider Practice Location Address
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Address Line | 2008 RUGGED DR
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City | DALLAS
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State | TX
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Zip | 75224-1124
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Country | US
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Telephone | 972-365-5921
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Fax |
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Provider Business Mailing Address
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Address Line | 2008 RUGGED DR
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City | DALLAS
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State | TX
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Zip | 75224-1124
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Country | US
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Telephone | 972-365-5921
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LARA HASTINGS
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Credential | PSY.D.
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Telephone | 972-365-5921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 32014
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License Number State | TX
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