Provider Demographics
NPI:1558128553
Name:LATITUDE THERAPY ARKANSAS LLC
Entity Type:Organization
Organization Name:LATITUDE THERAPY ARKANSAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:TALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-410-9670
Mailing Address - Street 1:8130 BALSON AVE
Mailing Address - Street 2:
Mailing Address - City:ST.LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130
Mailing Address - Country:US
Mailing Address - Phone:314-410-9670
Mailing Address - Fax:855-611-8213
Practice Address - Street 1:900 SE 5TH STREET
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712
Practice Address - Country:US
Practice Address - Phone:479-363-5820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health