Provider Demographics
NPI:1871959585
Name:FLORENCE, LATISHA JOLENE (LPC)
Entity type:Individual
Prefix:MS
First Name:LATISHA
Middle Name:JOLENE
Last Name:FLORENCE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:LATISHA
Other - Middle Name:JOLENE
Other - Last Name:CRESON-BEATY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2325 E LUNAR ST
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-1759
Mailing Address - Country:US
Mailing Address - Phone:417-200-2169
Mailing Address - Fax:
Practice Address - Street 1:281 US HIGHWAY 60 W
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-1432
Practice Address - Country:US
Practice Address - Phone:417-200-2169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015043559101YM0800X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor