Provider Demographics
NPI:1124371703
Name:BURNS, LATREETA ALICE (MSW, CSW)
Entity Type:Individual
Prefix:MRS
First Name:LATREETA
Middle Name:ALICE
Last Name:BURNS
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6544 W LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-3019
Mailing Address - Country:US
Mailing Address - Phone:414-839-8105
Mailing Address - Fax:
Practice Address - Street 1:6544 W LAWN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-3019
Practice Address - Country:US
Practice Address - Phone:414-839-8105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI297-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist