Provider Demographics
NPI:1588211585
Name:LARA, ROBERTO
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:LARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6284 S WESTLILAC DR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-3857
Mailing Address - Country:US
Mailing Address - Phone:385-377-9308
Mailing Address - Fax:
Practice Address - Street 1:4190 S HIGHLAND DR STE 112
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84124-2669
Practice Address - Country:US
Practice Address - Phone:385-377-9308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical