Individual
LATASHA RENEE BURNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S, LMFT
Contact information
Practice address
1201 NW ARLINGTON AVE, SUITE#E, LAWTON, OK 73507-6570
(580) 699-8680
(580) 699-8681
Mailing address
1201 NW ARLINGTON AVE, SUITE#E, LAWTON, OK 73507-6570
(580) 699-8680
(580) 699-8681
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
106H00000X
Marriage & Family Therapist
Primary
938
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200343820A
—
OK
01
—
452556312
TRICARE
OK
Enumeration date
02/14/2007
Last updated
10/20/2012
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