Individual
MR. MARIO LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
3176 LANCER ST, PORTAGE, IN 46368-4408
(219) 763-8823
Mailing address
579 W 450 S, HEBRON, IN 46341-8819
(219) 763-8823
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
02/06/2012
Last updated
02/06/2012
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