Individual provider · Type 1 NPI

Mario Lara, BA

Mental Health Counselor · Portage, IN

NPI number 1306118468 Active

Practice location

3176 Lancer St
Portage, IN 46368-4408

Mailing address

579 W 450 S
Hebron, IN 46341-8819

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

Mental Health Counselor: Definition to come...

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About NPI 1306118468

Mario Lara, BA's National Provider Identifier is 1306118468, issued on Feb 6, 2012. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Portage, IN. The record was last updated on Feb 6, 2012.