Individual
KELLYN LARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2121 S 125TH EAST AVE STE 106, TULSA, OK 74129-5800
(918) 574-8442
(619) 374-7134
Mailing address
16782 VON KARMAN AVE STE 11, IRVINE, CA 92606-2417
(855) 223-7123
(619) 374-7134
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
OK
Other
Enumeration date
04/01/2022
Last updated
06/25/2025
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