Provider Demographics
NPI:1710604269
Name:LARA-SMITH, TRUDIE (PHD; LMFT)
Entity type:Individual
Prefix:DR
First Name:TRUDIE
Middle Name:
Last Name:LARA-SMITH
Suffix:
Gender:F
Credentials:PHD; LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4273 MONTGOMERY BLVD NE STE K220
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6748
Mailing Address - Country:US
Mailing Address - Phone:505-554-1283
Mailing Address - Fax:505-207-6167
Practice Address - Street 1:4253 MONTGOMERY BLVD NE STE G130
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1106
Practice Address - Country:US
Practice Address - Phone:505-554-1283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2024-0630106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist