Provider Demographics
NPI:1508035353
Name:LATTIE, DAYLE CATHLEEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAYLE
Middle Name:CATHLEEN
Last Name:LATTIE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-2856
Mailing Address - Country:US
Mailing Address - Phone:417-861-6214
Mailing Address - Fax:254-313-3196
Practice Address - Street 1:1638C E REPUBLIC RD
Practice Address - Street 2:NONE
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6509
Practice Address - Country:US
Practice Address - Phone:417-861-6214
Practice Address - Fax:417-882-7765
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999140464103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical