Provider Demographics
NPI:1396487922
Name:BELL, LATYRA
Entity type:Individual
Prefix:
First Name:LATYRA
Middle Name:
Last Name:BELL
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 1:1021 MOLLY BARR RD APT 18
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-2490
Mailing Address - Country:US
Mailing Address - Phone:662-307-0325
Mailing Address - Fax:
Practice Address - Street 1:235 S MURPHREE ST
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:MS
Practice Address - Zip Code:38951-9779
Practice Address - Country:US
Practice Address - Phone:662-989-4099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker