MEDICARE: TAMARA SHELLEE LATHAM LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	09924194	CO

General Provider Information

NPI Number	:	1265981278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA SHELLEE LATHAM LCSW

Provider Business Mailing Address
First Line	:	4455 KASHMIRE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7610
Country	:	US
Telephone Number	:	719-357-1810
Fax Number	:

Provider Business Practice Location Address
First Line	:	5590 N ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3616
Country	:	US
Telephone Number	:	719-357-1810
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2016
Last Update Date	:	09/24/2024

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