Provider Demographics
NPI:1366977407
Name:DOWTIN, LATRICE L (PHD, LCPC, NCSP)
Entity type:Individual
Prefix:DR
First Name:LATRICE
Middle Name:L
Last Name:DOWTIN
Suffix:
Gender:F
Credentials:PHD, LCPC, NCSP
Other - Prefix:
Other - First Name:RYLEIGH
Other - Middle Name:
Other - Last Name:DOWTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LCPC, NCSP
Mailing Address - Street 1:2920 MERAMEC ST UNIT 26909
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-4462
Mailing Address - Country:US
Mailing Address - Phone:202-838-7529
Mailing Address - Fax:
Practice Address - Street 1:2920 MERAMEC ST UNIT 26909
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-4462
Practice Address - Country:US
Practice Address - Phone:202-838-7529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTMPC62101YM0800X
DCPRC200001793101YP2500X
MDLC8553101YP2500X
MO2021026279101YP2500X
103TS0200X
CA34407103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool