Provider Demographics
NPI:1659853026
Name:THOMAS, LATISHE
Entity Type:Individual
Prefix:
First Name:LATISHE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13303 LAKE EXCURSION CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-5577
Mailing Address - Country:US
Mailing Address - Phone:409-600-4360
Mailing Address - Fax:
Practice Address - Street 1:13303 LAKE EXCURSION CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-5577
Practice Address - Country:US
Practice Address - Phone:409-600-4360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-03
Last Update Date:2018-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator