Provider Demographics
NPI:1609472638
Name:BROWN, LATICHA MONET (HIGH SCHOOL DIPLOMA)
Entity Type:Individual
Prefix:
First Name:LATICHA
Middle Name:MONET
Last Name:BROWN
Suffix:
Gender:F
Credentials:HIGH SCHOOL DIPLOMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 N RANCHO DR APT 264
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3136
Mailing Address - Country:US
Mailing Address - Phone:702-628-3240
Mailing Address - Fax:
Practice Address - Street 1:1513 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3916
Practice Address - Country:US
Practice Address - Phone:702-703-5537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst