Provider Demographics
NPI:1326680901
Name:HART, LATRESA (LSW)
Entity Type:Individual
Prefix:MRS
First Name:LATRESA
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7941 CASTLEWAY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1953
Mailing Address - Country:US
Mailing Address - Phone:317-472-8511
Mailing Address - Fax:
Practice Address - Street 1:7941 CASTLEWAY DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1953
Practice Address - Country:US
Practice Address - Phone:317-472-8511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health