Provider Demographics
NPI:1417387739
Name:LATTIE PSYCHOLOGICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:LATTIE PSYCHOLOGICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LATTIE
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:417-861-6214
Mailing Address - Street 1:222 MAGIC LN
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-9348
Mailing Address - Country:US
Mailing Address - Phone:417-861-6214
Mailing Address - Fax:
Practice Address - Street 1:935 W RALPH HALL PKWY
Practice Address - Street 2:#105
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-8701
Practice Address - Country:US
Practice Address - Phone:972-772-8484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36497103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty