MEDICARE: GENERATIONAL THERAPY PLLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1235072802
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERATIONAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	800 E ASH LN APT 3423
Second Line	:
City	:	EULESS
State	:	TX
Zip	:	76039-5719
Country	:	US
Telephone Number	:	972-741-8409
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 E ASH LN APT 3423
Second Line	:
City	:	EULESS
State	:	TX
Zip	:	76039-5719
Country	:	US
Telephone Number	:	972-741-8409
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ASHLYN RENEE LATHAM
Credential	:	LPC
Telephone Number	:	972-741-8409

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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