Provider Demographics
NPI:1427360213
Name:LAFFERTY, LATOSHA WATTS (BCBA)
Entity Type:Individual
Prefix:
First Name:LATOSHA
Middle Name:WATTS
Last Name:LAFFERTY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8650 COMMERCE PARK PL STE A-1
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3174
Mailing Address - Country:US
Mailing Address - Phone:317-388-8131
Mailing Address - Fax:317-597-1130
Practice Address - Street 1:8650 COMMERCE PARK PL STE A-1
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-3174
Practice Address - Country:US
Practice Address - Phone:317-388-8131
Practice Address - Fax:317-597-1130
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-11-8896103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300011473Medicaid