| Doctor Name: | DONALD THADDEUS LATOCHA |
| NPI Number: | 1417214115 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.A. L.C.P.C. |
| License Number: | 180007843 |
| Business Practice Address: | 555 E North St Suite D Bradley, IL - 609151226 |
| Business Phone Number: | 8159358133 |
| Business Fax Number: | |
| Mailing Address: | 555 E North St Ste D, BRADLEY |
| State: | IL |
| Postal Code: | 609151232 |
| Phone Number: | 8159358133 |
| Fax Number: | |
| NPI Enumeration Date: | 04/18/2012 |
| NPI Last Update Date: | 04/18/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 180007843 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |