Basic Information
| Provider Information | |||||||||
| NPI: | 1194145854 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAMOS LAKE | ||||||||
| FirstName: | LATOSHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1216 NW 32ND ST | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852206088 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7050 AIR DEPOT BLVD | ||||||||
| Address2: | |||||||||
| City: | TINKER AFB | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731458716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055826603 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2014 | ||||||||
| LastUpdateDate: | 03/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 103TC0700X | 0005695 | CO | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.