Healthcare Provider Details

I. General information

NPI: 1194145854
Provider Name (Legal Business Name): LATOSHA RAMOS LAKE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 MAGNOLIA CT STE 117
MOORE OK
73160-1433
US

IV. Provider business mailing address

1201 MAGNOLIA CT STE 117
MOORE OK
73160-1433
US

V. Phone/Fax

Practice location:
  • Phone: 405-309-1345
  • Fax: 866-394-8572
Mailing address:
  • Phone: 405-309-1345
  • Fax: 866-394-8572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0005695
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1449
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: