Provider Demographics
NPI:1619652716
Name:LATHAM, LAUREN REBECCA (MA, NCC, LPC, CTT II)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:REBECCA
Last Name:LATHAM
Suffix:
Gender:F
Credentials:MA, NCC, LPC, CTT II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 4TH ST APT E
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-8010
Mailing Address - Country:US
Mailing Address - Phone:681-285-7287
Mailing Address - Fax:
Practice Address - Street 1:330 4TH ST APT E
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-8010
Practice Address - Country:US
Practice Address - Phone:681-285-7287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2592101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty