Individual
DR. EDWARD E LATHAM JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
404 E MARKET ST, KINGSPORT, TN 37660-4828
(423) 392-6898
(423) 392-6900
Mailing address
404 E MARKET ST, KINGSPORT, TN 37660-4828
(423) 392-6898
(423) 392-6900
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
P1405
TN
103TA0400X
Addiction (Substance Use Disorder) Psychologist
P1405
TN
103TA0700X
Adult Development & Aging Psychologist
P1405
TN
103TC0700X
Clinical Psychologist
Primary
P1405
TN
103TP2701X
Group Psychotherapy Psychologist
P1405
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0099539
BCBSTN
TN
01
—
063454
BCBS VA
TN
01
—
132696
VALUE OPTIONS
TN
01
—
1437005
UMWA
TN
01
—
241583000
MAGELLAN
TN
01
—
4067035
BCBSTN-MEDICAL
TN
01
—
4418397
AETNA
TN
01
—
6109533
UNITED HEALTHCARE
TN
01
—
9213176
PHCS
TN
Enumeration date
02/01/2007
Last updated
01/24/2012
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