Fonda Gail Latham, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

00557 Issued in TX

Practice address

1305 S Baxter Ave
Tyler, TX 75701-3404

Phone

(903) 714-1130

NPI assigned

Mar 9, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Samaritan Center for Counseling and Pastoral Care, Inc

  • Clinical Social Worker
  • Austin, TX
  • NPI 1881129328
  NPD (past)
• Samaritan Center for Counseling and Pastoral Care, Inc.

  • Community/Behavioral Health Agency
  • Austin, TX
  • NPI 1801936133
  NPD (past)

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306978135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 HENRY DR",
            "city": "BULLARD",
            "state": "TX",
            "postal_code": "757579375",
            "telephone_number": "903-714-1130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 S BAXTER AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757013404",
            "telephone_number": "903-714-1130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LATHAM",
        "first_name": "FONDA",
        "middle_name": "GAIL",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "00557",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John A Larrinaga, MD
• Larry M Chism PC (Vision Source of Tyler)
• Darren Thomas Larsen, CSFA
• Nicole Larsen
• Austin Thomas Lash, M.D.
• Ayad Latif, M.D.
• Sherif Medhat Latif, MD
• Htun Latt, M.D.
• Paul Norman Latta, DDS
• Laurie Dowell (Arise Prosthetics)

• Clinical Social Worker in Tyler, TX
• Providers in Tyler, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.