Provider Demographics
NPI:1972905750
Name:CONRAD-SHEARBURN, LARA (PHD)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:CONRAD-SHEARBURN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 OAKWELL FARMS PKWY STE 138
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-1725
Mailing Address - Country:US
Mailing Address - Phone:210-819-5941
Mailing Address - Fax:
Practice Address - Street 1:1919 OAKWELL FARMS PKWY STE 138
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-1725
Practice Address - Country:US
Practice Address - Phone:210-819-5941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0838103T00000X
MD05598103T00000X
TX38931103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist