Provider Demographics
NPI:1891593307
Name:LATHAM, KACY DAWN
Entity type:Individual
Prefix:
First Name:KACY
Middle Name:DAWN
Last Name:LATHAM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 N MUNDAY AVE
Mailing Address - Street 2:
Mailing Address - City:MUNDAY
Mailing Address - State:TX
Mailing Address - Zip Code:76371-1903
Mailing Address - Country:US
Mailing Address - Phone:325-668-3852
Mailing Address - Fax:
Practice Address - Street 1:421 N MUNDAY AVE
Practice Address - Street 2:
Practice Address - City:MUNDAY
Practice Address - State:TX
Practice Address - Zip Code:76371-1903
Practice Address - Country:US
Practice Address - Phone:325-668-3852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96122101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health