Basic Information
| Provider Information | |||||||||
| NPI: | 1972638971 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LATONA | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | BA, CACII | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8405 E HAMPDEN AVE | ||||||||
| Address2: | APT. 19K | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802314841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202611964 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1733 VINE ST | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802061119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035041074 | ||||||||
| FaxNumber: | 3033949820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 6382 | CO | X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.