1053857086 NPI number — MS. LATOYIA C. WEBB MS, LPC, SAC-IT

Table of content: MS. LATOYIA C. WEBB MS, LPC, SAC-IT (NPI 1053857086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053857086 NPI number — MS. LATOYIA C. WEBB MS, LPC, SAC-IT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBB
Provider First Name:
LATOYIA
Provider Middle Name:
C.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC, SAC-IT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053857086
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4130 W MARTIN DR APT 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53208-2750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-702-7373
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4130 W MARTIN DR APT 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53208-2750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-702-7373
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/14/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  18160-130 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: TPMC4485 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 8252-125 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1053857086 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1053857086 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".