Provider Demographics
NPI:1891061545
Name:LATIMER, KELSEY M (PHD)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:M
Last Name:LATIMER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 BAYTREE AVE
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-5868
Mailing Address - Country:US
Mailing Address - Phone:940-765-8838
Mailing Address - Fax:
Practice Address - Street 1:4500 BAYTREE AVE
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-5868
Practice Address - Country:US
Practice Address - Phone:940-765-8839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35191103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling