Provider Demographics
NPI:1174293625
Name:WHITLEY, LATASHA L (MA LPC, ATR)
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:L
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:MA LPC, ATR
Other - Prefix:
Other - First Name:LATASHA
Other - Middle Name:L
Other - Last Name:STRATTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7601 S KOSTNER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-1126
Mailing Address - Country:US
Mailing Address - Phone:708-931-8122
Mailing Address - Fax:
Practice Address - Street 1:7601 S KOSTNER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-1126
Practice Address - Country:US
Practice Address - Phone:708-931-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178013476101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional