Provider Demographics
NPI:1942570551
Name:GATER, LATANYA DENISE
Entity Type:Individual
Prefix:MS
First Name:LATANYA
Middle Name:DENISE
Last Name:GATER
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 1:5016 LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-2500
Mailing Address - Country:US
Mailing Address - Phone:313-770-4800
Mailing Address - Fax:
Practice Address - Street 1:15818 TULLER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-1240
Practice Address - Country:US
Practice Address - Phone:313-770-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program