Provider Demographics
NPI:1316228117
Name:LATTA, CARRI RENE (MA, LLPC)
Entity Type:Individual
Prefix:
First Name:CARRI
Middle Name:RENE
Last Name:LATTA
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:KALKASKA
Mailing Address - State:MI
Mailing Address - Zip Code:49646-0099
Mailing Address - Country:US
Mailing Address - Phone:231-258-6855
Mailing Address - Fax:
Practice Address - Street 1:303 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:KALKASKA
Practice Address - State:MI
Practice Address - Zip Code:49646-8424
Practice Address - Country:US
Practice Address - Phone:231-258-6855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802078495104100000X
MI6401223280101YP2500X
MI6401009271101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICOUN 09-99429OtherMICHIGAN DEPT OF HUMAN SERVICES