Individual
MRS. HEATHER DANIELLE LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
HEATHER BENNETT, M.A
Contact information
Practice address
320 N MAIN AVE STE 201D, GRESHAM, OR 97030-7242
(503) 974-8310
Mailing address
320 N MAIN AVE STE 201D, GRESHAM, OR 97030-7242
(503) 974-8310
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
REGISTERED INTERN
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
OR
Other
Enumeration date
07/31/2010
Last updated
10/23/2023
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