Individual provider · NPI-1

Latara Tashai' Buck

Counselor, Addiction (Substance Use Disorder) · Los Angeles, CA

NPI number1790414712
StatusActive
Last updated in NPPESSep 24, 2024

Details

NPI
1790414712
Entity type
Individual (NPI-1)
Name
Latara Tashai' Buck
Sex
Female
Sole proprietor
No
Enumeration date
Jun 6, 2022
Certification date
Sep 24, 2024
Last updated
Sep 24, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
101YA0400X Counselor, Addiction (Substance Use Disorder)17788CAYes
225800000X Recreation Therapist––

Practice location

12021 Wilmington Ave Ste 300
Los Angeles, CA 90059-3019

Phone 424-454-6020

Mailing address

1000 N Alameda St Ste 390
Los Angeles, CA 90012-1804

Phone 424-454-6020

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