Healthcare Provider Details

I. General information

NPI: 1467400903
Provider Name (Legal Business Name): BETH NALL LATELLA LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 DAWN LN
WAVERLY OH
45690-9695
US

IV. Provider business mailing address

102 DAWN LN
WAVERLY OH
45690-9695
US

V. Phone/Fax

Practice location:
  • Phone: 740-947-7783
  • Fax: 740-947-4226
Mailing address:
  • Phone: 740-947-7783
  • Fax: 740-947-4226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE-0002375
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: