Provider Demographics
NPI:1699110577
Name:SCHMIDT, LATONIA R (LMFT)
Entity type:Individual
Prefix:
First Name:LATONIA
Middle Name:R
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LATONIA
Other - Middle Name:R
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:312 AB WADE RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-4905
Mailing Address - Country:US
Mailing Address - Phone:615-788-5589
Mailing Address - Fax:
Practice Address - Street 1:607B LARKIN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-5007
Practice Address - Country:US
Practice Address - Phone:615-788-5589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN533106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist