Latara Anderson, LCSW
Social Worker, Clinical in Gallup, NM. Individual provider (NPI-1).
NPI number1255088563
StatusActive
Last updated in NPPESJul 16, 2025
Details
- NPI
- 1255088563
- Entity type
- Individual (NPI-1)
- Name
- Latara Anderson
- Credential
- LCSW
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Mar 7, 2022
- Certification date
- Jul 3, 2025
- Last updated
- Jul 16, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | SWB-2025-0420 | NM | Yes |
| 101YM0800X | Counselor, Mental Health | SW19622 | FL |
Practice location
2105 Hasler Valley RdGallup, NM 87301
Phone 505-413-3447
Mailing address
599 Siesta Key AveTavares, FL 32778-5911
Phone 786-925-8434
Other practice locations
599 Siesta Key Ave
Tavares, FL 32778-5911
Tavares, FL 32778-5911
Phone 786-925-8434
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