Provider Demographics
NPI:1285058826
Name:WALDRUP MCATEE, LATANIA CHANELL
Entity type:Individual
Prefix:
First Name:LATANIA
Middle Name:CHANELL
Last Name:WALDRUP MCATEE
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 1:515 W CAMP ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-1648
Mailing Address - Country:US
Mailing Address - Phone:765-482-5900
Mailing Address - Fax:
Practice Address - Street 1:515 W CAMP ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-1648
Practice Address - Country:US
Practice Address - Phone:765-482-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)