| Doctor Name: | MISS LARA ANN FREDA |
| NPI Number: | 1053491225 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ED.S. SCHOOL PSYCH |
| License Number: | |
| Business Practice Address: | 9419 W Van Buren St Tolleson, AZ - 853532804 |
| Business Phone Number: | 6234784239 |
| Business Fax Number: | |
| Mailing Address: | 16429 S 33rd St, PHOENIX |
| State: | AZ |
| Postal Code: | 850487845 |
| Phone Number: | 6234784239 |
| Fax Number: | |
| NPI Enumeration Date: | 10/16/2006 |
| NPI Last Update Date: | 07/26/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |