Provider Demographics
NPI:1720411937
Name:LATTIMORE, HORACE JR (LLPC,CAADC)
Entity Type:Individual
Prefix:MR
First Name:HORACE
Middle Name:
Last Name:LATTIMORE
Suffix:JR
Gender:M
Credentials:LLPC,CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:973 HAMPTONS CT APT 6
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5693
Mailing Address - Country:US
Mailing Address - Phone:231-670-3416
Mailing Address - Fax:
Practice Address - Street 1:1823 COMMERCE ST.
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442
Practice Address - Country:US
Practice Address - Phone:231-728-2138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012842101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)