Provider Demographics
NPI:1639888738
Name:KERRILYNN LATTA LCSW LLC
Entity Type:Organization
Organization Name:KERRILYNN LATTA LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KERRILYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:LATTA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:623-203-5151
Mailing Address - Street 1:11225 N 28TH DR STE A-10214
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-5606
Mailing Address - Country:US
Mailing Address - Phone:623-203-5151
Mailing Address - Fax:480-718-7487
Practice Address - Street 1:11225 N 28TH DR STE A-10214
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-5606
Practice Address - Country:US
Practice Address - Phone:623-203-5151
Practice Address - Fax:480-718-7487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health