Healthcare Provider Details

I. General information

NPI: 1700309945
Provider Name (Legal Business Name): JOEL MARK LAATSCH LMHC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 NIKKI VIEW DRIVE
BRANDON FL
33511
US

IV. Provider business mailing address

1119 NIKKI VIEW DR
BRANDON FL
33511-4879
US

V. Phone/Fax

Practice location:
  • Phone: 813-734-5672
  • Fax: 813-248-5999
Mailing address:
  • Phone: 813-734-5672
  • Fax: 813-248-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13522
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: