Jessica A Gonzales-Latchaw, LPC
Individual provider Active NPI Mental Health Counselor · Fort Worth, TX
NPI 1669253175 · NPPES record last updated Oct 10, 2023
Key facts
- NPI
- 1669253175
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 77611 (TX)
- Practice address
- 1616 Mistletoe Blvd Apt 100
Fort Worth, TX 76104-4047 - Phone
- (817) 668-5210
- NPI assigned
- Oct 10, 2023
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 77611 | TX | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 77611 | TX | Yes |
Addresses
Primary practice location
1616 Mistletoe Blvd Apt 100
Fort Worth, TX 76104-4047
Mailing address
1616 Mistletoe Blvd Apt 100
Fort Worth, TX 76104-4047
Phone (817) 668-5210
Other providers in Fort Worth, TX
- Kirsten A Gomez
- Stephanie Marie Gomez
- Anjaunette Denise Gonder
- Grace K Gongidi
- Preetam Gongidi
- Amanda Danette Gonzales
- Christopher Ray Gonzales
- David T Gonzales
- Jaime Gonzales
- Lena Gonzales
All providers in Fort Worth, TX · Mental Health Counselor in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 10, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.