Provider Demographics
NPI:1477260578
Name:MAMOU, CHRISTY (PSY,D)
Entity Type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:
Last Name:MAMOU
Suffix:
Gender:F
Credentials:PSY,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1754
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-1754
Mailing Address - Country:US
Mailing Address - Phone:225-286-9355
Mailing Address - Fax:
Practice Address - Street 1:20108 BUR OAK DR
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-5352
Practice Address - Country:US
Practice Address - Phone:225-286-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA250896164W00000X
LACM-100691101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse