Individual
DR. TIFFANY NYCOLE LARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
1400 E IRVING PARK RD, STREAMWOOD, IL 60107-3201
(630) 837-9000
(630) 837-2639
Mailing address
1400 E IRVING PARK RD, STREAMWOOD, IL 60107-3201
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071008128
IL
Other
Enumeration date
08/15/2014
Last updated
08/15/2014
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