| Lara Waldenmaier Llc | |
|
5900 Som Center Rd Ste 12-203 Willoughby OH 44094-3086 | |
| (440) 540-5258 | |
| Not Available |
| Full Name | Lara Waldenmaier Llc |
|---|---|
| Speciality | Counselor |
| Location | 5900 Som Center Rd Ste 12-203, Willoughby, Ohio |
| Authorized Official Name and Position | Lara Waldenmaier (PROFESSIONAL CLINICAL COUNSELOR) |
| Authorized Official Contact | 4405256825 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lara Waldenmaier Llc 5900 Som Center Rd Ste 12-203 Willoughby OH 44094-3086 Ph: (440) 540-5258 | Lara Waldenmaier Llc 5900 Som Center Rd Ste 12-203 Willoughby OH 44094-3086 Ph: (440) 540-5258 |
| NPI Number | 1629659610 |
|---|---|
| Provider Enumeration Date | 04/20/2021 |
| Last Update Date | 04/20/2021 |
| Certification Date | 04/20/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629659610 | NPI | - | NPPES |
| CS1625600131 | Other | OH | CARESOURCE |
| 0185639 | Medicaid | OH | |
| 13815586 | Other | OH | CAQH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
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