Basic Information
| Provider Information | |||||||||
| NPI: | 1972220283 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LATTEIER | ||||||||
| FirstName: | MINDY | ||||||||
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| Credential: | MFT INTERN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20891 UPPER LOWLAND AVE | ||||||||
| Address2: | |||||||||
| City: | EAGLE RIVER | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995779513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707129448 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1825 ACADEMY DR STE A | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995075391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075227090 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2022 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | NONE | 01 | NONE | OTHER |