Provider Demographics
NPI:1265981278
Name:LATHAM, TAMARA SHELLEE (LCSW)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:SHELLEE
Last Name:LATHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:SHELLEE
Other - Last Name:WHITING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4455 KASHMIRE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7610
Mailing Address - Country:US
Mailing Address - Phone:719-357-1810
Mailing Address - Fax:
Practice Address - Street 1:5590 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3616
Practice Address - Country:US
Practice Address - Phone:719-357-1810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099241941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical