Provider Demographics
NPI:1760106397
Name:OAKS, LATECIA ANSHA (LMSW)
Entity Type:Individual
Prefix:
First Name:LATECIA
Middle Name:ANSHA
Last Name:OAKS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15214 SORRENTO BAY CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77318-1352
Mailing Address - Country:US
Mailing Address - Phone:979-635-0667
Mailing Address - Fax:
Practice Address - Street 1:15214 SORRENTO BAY CIR
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77318-1352
Practice Address - Country:US
Practice Address - Phone:979-635-0667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105762104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty