Provider Demographics
NPI:1477752467
Name:MONSOUR, LOUISE (LMFT)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:MONSOUR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 DWIGHT WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2633
Mailing Address - Country:US
Mailing Address - Phone:510-685-9446
Mailing Address - Fax:510-235-3923
Practice Address - Street 1:2006 DWIGHT WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2633
Practice Address - Country:US
Practice Address - Phone:510-685-9446
Practice Address - Fax:510-235-3923
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34870106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA764211Medicaid