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General NPI Number Information
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NPI Number | 1699262717
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Entity Type | Organization
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Legal Business Name | LATIBULE COUNSELING, PLLC
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Dates
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Enumeration Date | 04/14/2018
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Last Update Date | 04/14/2018
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Provider Practice Location Address
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Address Line | 281 W 24TH ST STE 139
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City | YUMA
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State | AZ
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Zip | 85364-8500
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Country | US
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Telephone | 928-247-6430
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Fax | 928-436-8669
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Provider Business Mailing Address
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Address Line | 3621 W 22ND PL UNIT B
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City | YUMA
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State | AZ
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Zip | 85364-7621
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Country | US
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Telephone | 928-247-6430
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Fax | 928-436-8669
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Authorized Official
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Title or Position | CLINICIAN
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Name | MILY GOMEZ
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Credential |
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Telephone | 928-247-6430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 16637
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License Number State | AZ
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