Provider Demographics
NPI:1346876141
Name:RIDEAUX, LATASHA (CPRSS)
Entity Type:Individual
Prefix:MISS
First Name:LATASHA
Middle Name:
Last Name:RIDEAUX
Suffix:
Gender:F
Credentials:CPRSS
Other - Prefix:MISS
Other - First Name:LATASHA
Other - Middle Name:DENISE
Other - Last Name:RIDEAUX
Other - Suffix:X
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5905 SE 68TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-1911
Mailing Address - Country:US
Mailing Address - Phone:405-822-1754
Mailing Address - Fax:
Practice Address - Street 1:10326 GREENBRIAR PKWY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7643
Practice Address - Country:US
Practice Address - Phone:405-759-3860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health