Provider Demographics
NPI:1588079057
Name:LATITUDES, INC
Entity type:Organization
Organization Name:LATITUDES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:DONNELLY
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-524-6307
Mailing Address - Street 1:6910 N MAIN ST
Mailing Address - Street 2:UNIT 13C
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-9680
Mailing Address - Country:US
Mailing Address - Phone:574-524-6307
Mailing Address - Fax:574-222-1507
Practice Address - Street 1:6910 N MAIN ST
Practice Address - Street 2:UNIT 13C
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-9680
Practice Address - Country:US
Practice Address - Phone:574-524-6307
Practice Address - Fax:574-222-1507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002503A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty