Provider Demographics
NPI:1770840662
Name:LATUCH, ALBERT D III (T-LP)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:D
Last Name:LATUCH
Suffix:III
Gender:M
Credentials:T-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 S BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-2232
Mailing Address - Country:US
Mailing Address - Phone:913-680-8889
Mailing Address - Fax:316-284-6490
Practice Address - Street 1:1009 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-2232
Practice Address - Country:US
Practice Address - Phone:316-680-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2720103TC0700X, 103TC1900X
KS2806103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical