Provider Demographics
NPI:1104244292
Name:NORMAN, LATONYA NOVELLA
Entity type:Individual
Prefix:
First Name:LATONYA
Middle Name:NOVELLA
Last Name:NORMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 S TOLEDO PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2017
Mailing Address - Country:US
Mailing Address - Phone:918-428-9905
Mailing Address - Fax:
Practice Address - Street 1:3550 S TOLEDO PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2017
Practice Address - Country:US
Practice Address - Phone:918-428-9905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health