Provider Demographics
NPI:1699437046
Name:LATTA, SUSAN REED (LMFT, FT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:REED
Last Name:LATTA
Suffix:
Gender:F
Credentials:LMFT, FT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3097 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37408-3093
Mailing Address - Country:US
Mailing Address - Phone:423-362-1094
Mailing Address - Fax:
Practice Address - Street 1:3097 BROAD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37408-3093
Practice Address - Country:US
Practice Address - Phone:423-362-1094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1327101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional