Individual
LATARA ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2105 HASLER VALLEY RD, GALLUP, NM 87301
(505) 413-3447
Mailing address
599 SIESTA KEY AVE, TAVARES, FL 32778-5911
(786) 925-8434
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
SW19622
FL
1041C0700X
Clinical Social Worker
Primary
SWB-2025-0420
NM
Other
Enumeration date
03/07/2022
Last updated
07/16/2025
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