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Individual

TONY LATHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RBT

Contact information

Practice address
14 SOCCER PARK RD, FENTON, MO 63026-2564
(314) 845-3900
(314) 845-3901
Mailing address
14 SOCCER PARK RD, FENTON, MO 63026-2564
(314) 354-5611
(314) 845-3901

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT1872846
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1992256945
ABA
Enumeration date
12/19/2019
Last updated
12/19/2019
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