Lara, Mayra

Lara, Mayra is an individual health care provider with primary practice located at 1200 S Elmira Ave , Russellville AR 72802-9646. She recently has only one registered license in Behavioral Health & Social Service Providers / Behavior Technician, which is considered as her primary health care specialty. Lara, Mayra can be contacted via phone (479) 968-7118.

Contact Information

Primary practice address
1200 S Elmira Ave Russellville AR 72802-9646
Phone: (479) 968-7118
Fax: (479) 968-8628
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavior Technician 106S00000X

Profile Details

NPI number 1700551009
LBN Legal business name Lara, Mayra
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 10th, 2021
Last updated Jan 13th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700551009 NPPES
Arkansas MEDICAID 273474706

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