Provider Demographics
NPI:1790401412
Name:LATHAM LIFEWORKS, LLC
Entity Type:Organization
Organization Name:LATHAM LIFEWORKS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:SONGY
Authorized Official - Last Name:LATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, RDN, CDE
Authorized Official - Phone:504-919-0134
Mailing Address - Street 1:3920 URI ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3086
Mailing Address - Country:US
Mailing Address - Phone:504-919-0134
Mailing Address - Fax:504-887-2721
Practice Address - Street 1:654 BROCKENBRAUGH CT
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-2712
Practice Address - Country:US
Practice Address - Phone:504-919-0134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty