MEDICARE: LATOSHA RENEE BROOKS LMFT

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	MI0196	NV

General Provider Information

NPI Number	:	1841590049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATOSHA RENEE BROOKS LMFT

Provider Business Mailing Address
First Line	:	4085 N RANCHO DR
Second Line	:	SUITE120
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3466
Country	:	US
Telephone Number	:	702-651-0507
Fax Number	:

Provider Business Practice Location Address
First Line	:	4085 N RANCHO DR
Second Line	:	SUITE120
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3466
Country	:	US
Telephone Number	:	702-651-0507
Fax Number	:

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

Provider Enumeration Date	:	10/22/2010
Last Update Date	:	06/10/2022

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