Provider Demographics
NPI:1083943302
Name:LARA, CRISTINA (LPC-S)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:LARA
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 TORREON ST
Mailing Address - Street 2:
Mailing Address - City:HIDALGO
Mailing Address - State:TX
Mailing Address - Zip Code:78557-3837
Mailing Address - Country:US
Mailing Address - Phone:569-249-0330
Mailing Address - Fax:
Practice Address - Street 1:1601 BUFFALO DR
Practice Address - Street 2:
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580-4115
Practice Address - Country:US
Practice Address - Phone:956-699-0231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63732101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1083943302Medicaid