Lake Norman Integrative Psychiatry

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

34660 Issued in NC

Legal business name

LAKE NORMAN INTEGRATIVE PSYCHIATRY

Practice address

116 S Main St Ste 301
Mooresville, NC 28115-2373

Phone

(704) 662-3200

Fax

(704) 662-1247

NPI assigned

May 11, 2007

Last updated

Oct 3, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Tracy Thompson Latz, M.D., M.S.NPI 1407879851

Title

Sole Owner

Phone

(704) 662-3200

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tracy Thompson Latz, M.D., M.S.

  • Psychiatry Physician
  • Mooresville, NC
  • NPI 1407879851
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191369600000",
    "number": "1174738520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 S MAIN ST STE 301",
            "address_2": "P.O. BOX 1247",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281152373",
            "telephone_number": "704-662-3200",
            "fax_number": "704-662-8731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 S MAIN ST STE 301",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281152373",
            "telephone_number": "704-662-3200",
            "fax_number": "704-662-1247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE NORMAN INTEGRATIVE PSYCHIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-11",
        "last_updated": "2007-10-03",
        "status": "A",
        "authorized_official_last_name": "LATZ",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "THOMPSON",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "704-662-3200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., M.S."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NC",
            "license": "34660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7951148",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR LATZ NPI NUMBER",
            "identifier": "1407879851",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Lake Norman OBGYN LLP

• Medical Specialty Clinic/Center in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Medical Specialty Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.