Provider Demographics
NPI:1982487229
Name:SOMATIC LATITUDE, LLC
Entity Type:Organization
Organization Name:SOMATIC LATITUDE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GIVIAN
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:785-301-1542
Mailing Address - Street 1:401 BROOKLAWN DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-8414
Mailing Address - Country:US
Mailing Address - Phone:785-226-0410
Mailing Address - Fax:
Practice Address - Street 1:227 BLUE EARTH PL STE 203E
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-6647
Practice Address - Country:US
Practice Address - Phone:785-301-1542
Practice Address - Fax:785-262-8393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-18
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty