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NPI Code Detail

MEDICARE: LATASHA WORTHAM

MEDICARE: LATASHA WORTHAM
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1831644186
Entity Type Code : Individual
Provider Name (Legal Business Name) : LATASHA WORTHAM
Provider Business Mailing Address
First Line : 2020 PINTO LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-4019
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2020 PINTO LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-4019
Country : US
Telephone Number : 702-868-2901
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2016
Last Update Date : 08/16/2016

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Directions to “ LATASHA WORTHAM ” Practice Location

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