Individual
LATRESA RENEE SIMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1777 ARMSTRONG ST. SUITE C., PORTAGE, IN 46368
(219) 841-9166
Mailing address
1777 ARMSTRONG ST. SUITE C., PORTAGE, IN 46368
(219) 841-9166
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
39004364A
IN
103TC2200X
Clinical Child & Adolescent Psychologist
39004364A
IN
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
3747A0650X
Attendant Care Provider
Primary
—
—
3747P1801X
Personal Care Attendant
—
—
Other
Enumeration date
10/22/2020
Last updated
03/04/2026
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