Provider Demographics
NPI:1922401249
Name:LATSHA, RON (MS, LPC)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:LATSHA
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 112576
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-2576
Mailing Address - Country:US
Mailing Address - Phone:907-764-0093
Mailing Address - Fax:
Practice Address - Street 1:101 E 9TH AVE STE 3A
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3651
Practice Address - Country:US
Practice Address - Phone:907-764-0093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK810101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK810OtherSTATE OF ALASKA, DEPARTMENT OF COMMERCE