Provider Demographics
NPI:1912434010
Name:BAXTER, LATRICE N (LMHC)
Entity Type:Individual
Prefix:
First Name:LATRICE
Middle Name:N
Last Name:BAXTER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:LATRICE
Other - Middle Name:N
Other - Last Name:CASIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 N. ILLINOIS STREET
Mailing Address - Street 2:16TH FLOOR, SOUTH TOWER
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204
Mailing Address - Country:US
Mailing Address - Phone:317-395-3716
Mailing Address - Fax:
Practice Address - Street 1:201 N. ILLINOIS STREET
Practice Address - Street 2:16TH FLOOR, SOUTH TOWER
Practice Address - City:INDIANPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204
Practice Address - Country:US
Practice Address - Phone:317-395-3716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003055A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health