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NPI Code Detail

MEDICARE: KIM LATCHIS MFT

MEDICARE: KIM LATCHIS MFT
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
1106H00000XMarriage & Family TherapistMFC 36862CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1KLA0923OTHERCALA CO DMH PROVIDER #

General Provider Information

NPI Number : 1841321916
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIM LATCHIS MFT
Provider Business Mailing Address
First Line : 6915 ETHEL AVE
Second Line :
City : NORTH HOLLYWOOD
State : CA
Zip : 91605-4703
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 920 E BROADWAY
Second Line :
City : GLENDALE
State : CA
Zip : 91205-1204
Country : US
Telephone Number : 818-242-8403
Fax Number : 818-242-3187
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 07/08/2007

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Directions to “ KIM LATCHIS MFT” Practice Location

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