Provider Demographics
NPI:1740621564
Name:OATES, LATOYA
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:OATES
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:PO BOX 26221
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-6221
Mailing Address - Country:US
Mailing Address - Phone:833-469-7859
Mailing Address - Fax:833-469-7859
Practice Address - Street 1:623 BEECHWOOD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-6236
Practice Address - Country:US
Practice Address - Phone:904-358-1211
Practice Address - Fax:904-358-1551
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH10708101YM0800X
FLPMH2004101YS0200X, 101YA0400X, 101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional