Provider Demographics
NPI:1144389297
Name:LATA, JEFFREY LAWRENCE (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LAWRENCE
Last Name:LATA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-1527
Mailing Address - Country:US
Mailing Address - Phone:630-845-8847
Mailing Address - Fax:
Practice Address - Street 1:1250 EXECUTIVE PL
Practice Address - Street 2:BUILDING 500
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-3807
Practice Address - Country:US
Practice Address - Phone:630-232-7457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist