MEDICARE: LATONIA R. SCHMIDT L.M.F.T.

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	106H00000X	Marriage & Family Therapist	533	TN

General Provider Information

NPI Number	:	1699110577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATONIA R. SCHMIDT L.M.F.T.

Provider Business Mailing Address
First Line	:	312 AB WADE RD
Second Line	:
City	:	PORTLAND
State	:	TN
Zip	:	37148-4905
Country	:	US
Telephone Number	:	615-788-5589
Fax Number	:

Provider Business Practice Location Address
First Line	:	607B LARKIN SPRINGS RD
Second Line	:
City	:	MADISON
State	:	TN
Zip	:	37115-5007
Country	:	US
Telephone Number	:	615-788-5589
Fax Number	:

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

Provider Enumeration Date	:	05/06/2013
Last Update Date	:	05/06/2013

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