Provider Demographics
NPI:1881016442
Name:MITCHELL, LATOYA MONIQUE
Entity Type:Individual
Prefix:MRS
First Name:LATOYA
Middle Name:MONIQUE
Last Name:MITCHELL
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 1:850 FM 1960 WEST
Mailing Address - Street 2:K2
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066
Mailing Address - Country:US
Mailing Address - Phone:713-259-4274
Mailing Address - Fax:713-583-9701
Practice Address - Street 1:850 FM 1960 WEST
Practice Address - Street 2:K2
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060
Practice Address - Country:US
Practice Address - Phone:713-259-4274
Practice Address - Fax:713-583-9701
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT108707225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist