Provider Demographics
NPI:1730346578
Name:WILKINSON STEWART, LARA LEIGH (MS, LPC)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:LEIGH
Last Name:WILKINSON STEWART
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:LEIGH
Other - Last Name:WILKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:PO BOX 1342
Mailing Address - Street 2:
Mailing Address - City:VIDOR
Mailing Address - State:TX
Mailing Address - Zip Code:77670-1342
Mailing Address - Country:US
Mailing Address - Phone:409-769-1824
Mailing Address - Fax:409-769-1829
Practice Address - Street 1:157 LOWE ST
Practice Address - Street 2:
Practice Address - City:VIDOR
Practice Address - State:TX
Practice Address - Zip Code:77662-3844
Practice Address - Country:US
Practice Address - Phone:409-769-1824
Practice Address - Fax:409-769-1829
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62334101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional