| Latrece Gaither, LLC | |
|
510 Ne Roberts Ave Ste 200 Gresham OR 97030-7484 | |
| (971) 236-2728 | |
| (855) 719-2524 |
| Full Name | Latrece Gaither, LLC |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 510 Ne Roberts Ave Ste 200, Gresham, Oregon |
| Authorized Official Name and Position | Latrece Gaither (OWNER/PROVIDER) |
| Authorized Official Contact | 9712362728 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Latrece Gaither, LLC Po Box 214 Fairview OR 97024-0214 | Latrece Gaither, LLC 510 Ne Roberts Ave Ste 200 Gresham OR 97030-7484 Ph: (971) 236-2728 |
| NPI Number | 1356065502 |
|---|---|
| Provider Enumeration Date | 09/30/2022 |
| Last Update Date | 09/30/2022 |
| Certification Date | 09/30/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356065502 | NPI | - | NPPES |
| 1316295587 | Other | OR | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | () | Primary |
| 106H00000X | Marriage & Family Therapist | () | Secondary |
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