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General NPI Number Information
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NPI Number | 1417771650
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Entity Type | Individual
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Provider Name | LATRICE TODD
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Gender | Female
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 02/22/2025
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Provider Practice Location Address
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Address Line | 1105 STONEWALL ST STE 503A
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City | GARLAND
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State | TX
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Zip | 75043-1697
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Country | US
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Telephone | 469-207-1049
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Fax |
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Provider Business Mailing Address
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Address Line | 3510 S HIGHWAY 161 STE 130-5022
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-7952
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Country | US
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Telephone | 945-342-2310
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 96533
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License Number State | TX
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