Provider Demographics
NPI:1386744415
Name:LATTA, WILLIAM WOODROW (PHD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WOODROW
Last Name:LATTA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4042 E. HAMPTON WAY
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726
Mailing Address - Country:US
Mailing Address - Phone:559-229-0659
Mailing Address - Fax:
Practice Address - Street 1:3133 NORTH MILLBROOK AVE.
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703
Practice Address - Country:US
Practice Address - Phone:559-453-8405
Practice Address - Fax:559-453-6733
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15309103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling