Provider Demographics
NPI:1962246587
Name:KIRKLAND, LATIA BREANNA
Entity type:Individual
Prefix:MRS
First Name:LATIA
Middle Name:BREANNA
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LATIA
Other - Middle Name:BREANNA
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17235 N 75TH AVE STE G120
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-0895
Mailing Address - Country:US
Mailing Address - Phone:480-812-4789
Mailing Address - Fax:
Practice Address - Street 1:17235 N 75TH AVE STE G120
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-0895
Practice Address - Country:US
Practice Address - Phone:480-812-4789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician