Provider Demographics
NPI:1255211439
Name:DEWALT, LATASHA (MED, LPC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:
Last Name:DEWALT
Suffix:
Gender:F
Credentials:MED, LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 KATY FWY STE 103
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-2263
Mailing Address - Country:US
Mailing Address - Phone:832-559-2622
Mailing Address - Fax:
Practice Address - Street 1:5225 KATY FWY STE 103
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-2263
Practice Address - Country:US
Practice Address - Phone:832-559-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-06
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100040101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional