MEDICARE: DR. LATOSHA RAMOS LAKE PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0005695	CO
2	390200000X	Student in an Organized Health Care Education/Training Program
3	101YM0800X	Mental Health Counselor
4	103TC0700X	Clinical Psychologist	1449	OK

General Provider Information

NPI Number	:	1194145854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LATOSHA RAMOS LAKE PSYD

Provider Business Mailing Address
First Line	:	1201 MAGNOLIA CT STE 117
Second Line	:
City	:	MOORE
State	:	OK
Zip	:	73160-1433
Country	:	US
Telephone Number	:	405-309-1345
Fax Number	:	866-394-8572

Provider Business Practice Location Address
First Line	:	1201 MAGNOLIA CT STE 117
Second Line	:
City	:	MOORE
State	:	OK
Zip	:	73160-1433
Country	:	US
Telephone Number	:	405-309-1345
Fax Number	:	866-394-8572

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2014
Last Update Date	:	04/23/2026

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