Provider Demographics
NPI:1366608689
Name:LATIMER, JUDY LYNN (LPC/RD/LD)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:LYNN
Last Name:LATIMER
Suffix:
Gender:F
Credentials:LPC/RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 ASH STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-4314
Mailing Address - Country:US
Mailing Address - Phone:580-255-5839
Mailing Address - Fax:
Practice Address - Street 1:1313 ASH STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-4314
Practice Address - Country:US
Practice Address - Phone:580-255-5839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4038101YP2500X
OK103TS0200X
OK710341-571133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered