Provider Demographics
NPI:1043799968
Name:RENEE, LATOSHA (MSW)
Entity Type:Individual
Prefix:
First Name:LATOSHA
Middle Name:
Last Name:RENEE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:LA TASHA
Other - Middle Name:
Other - Last Name:RENEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11740 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-1820
Mailing Address - Country:US
Mailing Address - Phone:918-437-9495
Mailing Address - Fax:
Practice Address - Street 1:11740 E 21ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129
Practice Address - Country:US
Practice Address - Phone:918-437-9495
Practice Address - Fax:918-560-1399
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker