Provider Demographics
NPI:1124543103
Name:LOUZON, PATRICK (EDS)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:LOUZON
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6853 DEER RIDGE RD APT 74
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-8315
Mailing Address - Country:US
Mailing Address - Phone:248-506-9333
Mailing Address - Fax:
Practice Address - Street 1:725 WESTMORELAND AVE
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-1261
Practice Address - Country:US
Practice Address - Phone:419-592-6991
Practice Address - Fax:419-599-7638
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21425484103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool