MEDICARE: WALTER LATHY M.F.T.

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	106H00000X	Marriage & Family Therapist	MFC12743	CA

General Provider Information

NPI Number	:	1598798118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER LATHY M.F.T.

Provider Business Mailing Address
First Line	:	5855 E NAPLES PLZ
Second Line	:	SUITE 310
City	:	LONG BEACH
State	:	CA
Zip	:	90803-5060
Country	:	US
Telephone Number	:	213-422-9929
Fax Number	:

Provider Business Practice Location Address
First Line	:	5855 E NAPLES PLZ
Second Line	:	SUITE 310
City	:	LONG BEACH
State	:	CA
Zip	:	90803-5060
Country	:	US
Telephone Number	:	213-422-9929
Fax Number	:

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	11/30/2016

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