Provider Demographics
NPI:1609315860
Name:CALLAHAN, LATANYA M (MED, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:LATANYA
Middle Name:M
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:MED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 W THOMAS ST STE D-232
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-2901
Mailing Address - Country:US
Mailing Address - Phone:985-634-2295
Mailing Address - Fax:
Practice Address - Street 1:1905 W THOMAS ST STE D-232
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-2901
Practice Address - Country:US
Practice Address - Phone:985-634-2295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6146101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health