Provider Demographics
NPI:1417214115
Name:LATOCHA, DONALD THADDEUS (MA LCPC)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:THADDEUS
Last Name:LATOCHA
Suffix:
Gender:M
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E NORTH ST STE D
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915-1232
Mailing Address - Country:US
Mailing Address - Phone:815-935-8133
Mailing Address - Fax:
Practice Address - Street 1:555 E NORTH ST
Practice Address - Street 2:SUITE D
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-1226
Practice Address - Country:US
Practice Address - Phone:815-935-8133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007843101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional