Doctor Name: | JAMES JEFFREY LATHAM |
NPI Number: | 1063769248 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MBS, LBP, LBHP |
License Number: | 0071 |
Business Practice Address: | 1201 Arlington St Ste G Ada, OK - 748204072 |
Business Phone Number: | 5803326851 |
Business Fax Number: | 5803106047 |
Mailing Address: | 16948 County Road 1517, ADA |
State: | OK |
Postal Code: | 748204953 |
Phone Number: | 5803200572 |
Fax Number: | 5803106047 |
NPI Enumeration Date: | 08/07/2012 |
NPI Last Update Date: | 08/07/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 0071 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |