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General NPI Number Information
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NPI Number | 1790401412
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Entity Type | Organization
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Legal Business Name | LATHAM LIFEWORKS, LLC
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Dates
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Enumeration Date | 10/14/2022
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Last Update Date | 12/01/2023
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Provider Practice Location Address
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Address Line | 654 BROCKENBRAUGH CT
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City | METAIRIE
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State | LA
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Zip | 70005-2712
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Country | US
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Telephone | 504-919-0134
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Fax |
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Provider Business Mailing Address
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Address Line | 3920 URI ST
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City | METAIRIE
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State | LA
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Zip | 70002-3086
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Country | US
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Telephone | 504-919-0134
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Fax | 504-887-2721
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Authorized Official
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Title or Position | DIETITIAN/COUNSELOR
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Name | JEANINE SONGY LATHAM
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Credential | LPC, RDN, CDE
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Telephone | 504-919-0134
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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