Provider Demographics
NPI:1821961053
Name:TRICE, LATASHA (LPCA)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:
Last Name:TRICE
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12501 BROADWAY ST APT 10106
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7413
Mailing Address - Country:US
Mailing Address - Phone:229-947-0923
Mailing Address - Fax:
Practice Address - Street 1:12501 BROADWAY ST APT 10106
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7413
Practice Address - Country:US
Practice Address - Phone:229-947-0923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC010332101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty