Individual
GABRIEL MICHAEL FELIX LARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BEHAVIOR ANALYST
Contact information
Practice address
3100 S CENTRAL AVE, CICERO, IL 60804-3956
(708) 863-3803
(708) 863-3863
Mailing address
222 N BROCKWAY ST APT 2, PALATINE, IL 60067-0423
(224) 443-8505
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
IL
103K00000X
Behavior Analyst
—
—
Other
Enumeration date
12/28/2018
Last updated
12/28/2018
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