Provider Demographics
NPI:1518853654
Name:LATIMER, TERRY LYNDELL JR
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:LYNDELL
Last Name:LATIMER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 W HANCOCK ST APT 1
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-1237
Mailing Address - Country:US
Mailing Address - Phone:863-614-5056
Mailing Address - Fax:
Practice Address - Street 1:300 INTERNATIONAL PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5028
Practice Address - Country:US
Practice Address - Phone:407-614-4299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician