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General NPI Number Information
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NPI Number | 1598996555
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Entity Type | Organization
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Legal Business Name | LATTER HOUSE COUNSELING SERVICES
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Dates
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Enumeration Date | 08/06/2009
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Last Update Date | 08/06/2009
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Provider Practice Location Address
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Address Line | 413 HISTORIC 66 W
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City | WAYNESVILLE
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State | MO
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Zip | 65583-2114
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Country | US
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Telephone | 573-774-4198
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Fax | 573-774-4951
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Provider Business Mailing Address
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Address Line | 413 HISTORIC 66 W
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City | WAYNESVILLE
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State | MO
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Zip | 65583-2114
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Country | US
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Telephone | 573-774-4198
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Fax | 573-774-4951
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Authorized Official
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Title or Position | OWNER
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Name | TONYA POWELL
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Credential | LPC
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Telephone | 573-855-6227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2006024099
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License Number State | MO
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