Provider Demographics
NPI:1619715059
Name:LARA, CHEYENNE (LPC)
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:
Last Name:LARA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 S CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67210-2463
Mailing Address - Country:US
Mailing Address - Phone:316-833-2949
Mailing Address - Fax:
Practice Address - Street 1:345 N RIVERVIEW ST STE 730
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4267
Practice Address - Country:US
Practice Address - Phone:316-202-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLPC04762101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional