Provider Demographics
NPI:1730468737
Name:MACKEY, LATANYA MICHELLE (LPC)
Entity Type:Individual
Prefix:
First Name:LATANYA
Middle Name:MICHELLE
Last Name:MACKEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1489
Mailing Address - Country:US
Mailing Address - Phone:314-371-6500
Mailing Address - Fax:314-371-6510
Practice Address - Street 1:2650 OLIVE STREET
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-1489
Practice Address - Country:US
Practice Address - Phone:314-371-6500
Practice Address - Fax:314-371-6510
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016000483101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional