Provider Demographics
NPI:1497636534
Name:LARA, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LARA
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23501 CINCO RANCH BLVD # 220
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3095
Mailing Address - Country:US
Mailing Address - Phone:832-776-8862
Mailing Address - Fax:
Practice Address - Street 1:21827 SIERRA LONG DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-4999
Practice Address - Country:US
Practice Address - Phone:832-776-8862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-23-266541103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst