Individual
LARA MATTINGLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6330 W THUNDERBIRD RD, GLENDALE, AZ 85306-4002
(623) 486-6000
Mailing address
5824 W ELECTRA LN, GLENDALE, AZ 85310-3636
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
4050322
AZ
Other
Enumeration date
08/18/2008
Last updated
08/18/2008
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