Provider Demographics
NPI:1487934154
Name:HARRIS, LARA (MA, MFT)
Entity type:Individual
Prefix:MS
First Name:LARA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 N. LARCHMONT BLVD, STE 202
Mailing Address - Street 2:LARCHMONT ASSOCIATES
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004
Mailing Address - Country:US
Mailing Address - Phone:213-500-5272
Mailing Address - Fax:
Practice Address - Street 1:252 N. LARCHMONT BLVD, STE 202
Practice Address - Street 2:LARCHMONT ASSOCIATES
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004
Practice Address - Country:US
Practice Address - Phone:213-500-5272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50193106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist