Provider Demographics
NPI:1598798118
Name:LATHY, WALTER (MFT)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:LATHY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 E NAPLES PLZ
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5060
Mailing Address - Country:US
Mailing Address - Phone:213-422-9929
Mailing Address - Fax:
Practice Address - Street 1:5855 E NAPLES PLZ
Practice Address - Street 2:SUITE 310
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5060
Practice Address - Country:US
Practice Address - Phone:213-422-9929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC12743106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist