Provider Demographics
NPI:1982871356
Name:BACY, LATRINA CAMILLE (BS)
Entity Type:Individual
Prefix:MISS
First Name:LATRINA
Middle Name:CAMILLE
Last Name:BACY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 WHEELER DRIVE
Mailing Address - Street 2:APT B
Mailing Address - City:COMMERCE
Mailing Address - State:TX
Mailing Address - Zip Code:75428
Mailing Address - Country:US
Mailing Address - Phone:903-442-5111
Mailing Address - Fax:
Practice Address - Street 1:442 B WHEELER DRIVE
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:TX
Practice Address - Zip Code:75428
Practice Address - Country:US
Practice Address - Phone:903-422-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor