Active NPI
Carmen Lee Latella, LAC
- Addiction (Substance Use Disorder) Counselor
- Minot, ND
National Provider Identifier
1962640128
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 1575
- Practice address
- 1015 S Broadway
Suite 18
Minot, ND 58701-4667 - Phone
- (701) 857-8500
- Fax
- (701) 857-8555
- NPI assigned
- Jan 27, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1575 | ND | Primary |
Addresses
Primary practice location
1015 S Broadway
Suite 18
Minot, ND 58701-4667
Mailing address
1015 S Broadway
Suite 18
Minot, ND 58701-4667
Phone (701) 857-8500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 054517 | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1575 | ND | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1233014400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233014400000",
"number": "1962640128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1015 S BROADWAY",
"address_2": "SUITE 18",
"city": "MINOT",
"state": "ND",
"postal_code": "587014667",
"telephone_number": "701-857-8500",
"fax_number": "701-857-8555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1015 S BROADWAY",
"address_2": "SUITE 18",
"city": "MINOT",
"state": "ND",
"postal_code": "587014667",
"telephone_number": "701-857-8500",
"fax_number": "701-857-8555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LATELLA",
"first_name": "CARMEN",
"middle_name": "LEE",
"name_prefix": "Mrs.",
"credential": "LAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-01-27",
"last_updated": "2009-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "ND",
"license": "1575",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "054517",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minot, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.