Provider Demographics
NPI:1972220283
Name:LATTEIER, MINDY (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:LATTEIER
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20891 UPPER LOWLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-9513
Mailing Address - Country:US
Mailing Address - Phone:970-712-9448
Mailing Address - Fax:
Practice Address - Street 1:1825 ACADEMY DR STE A
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-5391
Practice Address - Country:US
Practice Address - Phone:907-522-7090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE