Organization
LARA WALDENMAIER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LARA WALDENMAIER MA, LPCC (PROFESSIONAL CLINICAL COUNSELOR)
(440) 525-6825
Entity
Organization
Contact information
Practice address
5900 SOM CENTER RD STE 12-203, WILLOUGHBY, OH 44094-3086
(440) 540-5258
Mailing address
5900 SOM CENTER RD STE 12-203, WILLOUGHBY, OH 44094-3086
(440) 540-5258
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0185639
—
OH
01
—
13815586
CAQH
OH
01
—
CS1625600131
CARESOURCE
OH
Enumeration date
04/20/2021
Last updated
04/20/2021
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