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General NPI Number Information
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NPI Number | 1255088563
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Entity Type | Individual
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Provider Name | LATARA ANDERSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/07/2022
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 2105 HASLER VALLEY RD
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City | GALLUP
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State | NM
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Zip | 87301
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Country | US
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Telephone | 505-413-3447
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Fax |
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Provider Business Mailing Address
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Address Line | 599 SIESTA KEY AVE
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City | TAVARES
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State | FL
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Zip | 32778-5911
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Country | US
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Telephone | 786-925-8434
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | SW19622
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SWB-2025-0420
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License Number State | NM
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