Provider Demographics
NPI:1164288668
Name:MINOR, LATOYA S (LCSW)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:S
Last Name:MINOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 CASPIAN WAY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-2555
Mailing Address - Country:US
Mailing Address - Phone:817-681-4438
Mailing Address - Fax:
Practice Address - Street 1:1720 OAK VILLAGE BLVD STE 200B
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-7952
Practice Address - Country:US
Practice Address - Phone:817-681-4438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX590881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical