Provider Demographics
NPI:1386261436
Name:LARA BENEFIELD, LMFT
Entity type:Organization
Organization Name:LARA BENEFIELD, LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LARA
Authorized Official - Middle Name:NATASHA
Authorized Official - Last Name:BENEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:415-299-9942
Mailing Address - Street 1:51 ESSEX ST APT 11
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2445
Mailing Address - Country:US
Mailing Address - Phone:415-299-9942
Mailing Address - Fax:
Practice Address - Street 1:2915 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-2133
Practice Address - Country:US
Practice Address - Phone:415-299-9942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-05
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)