NPI 1255088563 · live from the CMS NPI Registry
Latara Anderson, LCSW
Social Worker, Clinical in Gallup, NM. National Provider Identifier 1255088563, active.
NPI record
| NPI | 1255088563 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Social Worker, Clinical 1041C0700X |
| Practice location | 2105 Hasler Valley Rd, Gallup, NM 87301 |
| Practice phone | 505-413-3447 |
| Mailing address | 599 Siesta Key Ave, Tavares, FL 32778 |
| Enumerated | March 7, 2022 |
| Last updated | July 16, 2025 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Counselor, Mental Health | 101YM0800X | SW19622 (FL) |
| Social Worker, Clinical primary | 1041C0700X | SWB-2025-0420 (NM) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.