Provider Demographics
NPI:1386771863
Name:LATA, KARI WITTMANN (LMFT, LCPC)
Entity type:Individual
Prefix:MRS
First Name:KARI
Middle Name:WITTMANN
Last Name:LATA
Suffix:
Gender:F
Credentials:LMFT, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1S080 E. MALLORY DR.
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-1527
Mailing Address - Country:US
Mailing Address - Phone:630-845-8847
Mailing Address - Fax:
Practice Address - Street 1:1935 BROOKDALE RD
Practice Address - Street 2:SUITE 119
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2771
Practice Address - Country:US
Practice Address - Phone:630-717-9408
Practice Address - Fax:630-778-9490
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005863101YM0800X
IL166000586106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health