Doctor Name: | DR. DOUGLAS J LATUSECK |
NPI Number: | 1528264488 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PSYD, LP |
License Number: | LP4822 |
Business Practice Address: | 7525 4th Ave Lino Lakes, MN - 550141006 |
Business Phone Number: | 6517176549 |
Business Fax Number: | 6517176697 |
Mailing Address: | 7525 4th Ave, LINO LAKES |
State: | MN |
Postal Code: | 550141006 |
Phone Number: | 6517176549 |
Fax Number: | 6517176697 |
NPI Enumeration Date: | 06/26/2007 |
NPI Last Update Date: | 11/28/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | LP4822 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |