Provider Demographics
NPI:1942007562
Name:LARA, MELISSA (LMFT-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:LARA
Suffix:
Gender:F
Credentials:LMFT-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 593012
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-0200
Mailing Address - Country:US
Mailing Address - Phone:726-217-2244
Mailing Address - Fax:
Practice Address - Street 1:14893 BANDERA RD STE 5A
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-3879
Practice Address - Country:US
Practice Address - Phone:210-376-8292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205683106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist