Provider Demographics
NPI:1952744161
Name:LATVA, JASON W (LPC, CSAC, ICS)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:W
Last Name:LATVA
Suffix:
Gender:M
Credentials:LPC, CSAC, ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-4931
Mailing Address - Country:US
Mailing Address - Phone:920-435-2093
Mailing Address - Fax:
Practice Address - Street 1:630 CHERRY ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4931
Practice Address - Country:US
Practice Address - Phone:920-435-2093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7386-125101YP2500X
WI15923-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional