Provider Demographics
NPI:1689343071
Name:HOGAN, LATRINA HOWARD (MASTERS OF SCIENCE)
Entity Type:Individual
Prefix:MRS
First Name:LATRINA
Middle Name:HOWARD
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MASTERS OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9144 KEATY DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1821
Mailing Address - Country:US
Mailing Address - Phone:318-871-6501
Mailing Address - Fax:
Practice Address - Street 1:3004 KNIGHT ST STE 149
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2502
Practice Address - Country:US
Practice Address - Phone:318-227-8390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LAPLC9579101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health