Provider Demographics
NPI:1508412313
Name:LOUIS, EGUENEL (LMHC)
Entity Type:Individual
Prefix:MR
First Name:EGUENEL
Middle Name:
Last Name:LOUIS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3354 SW MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-4915
Mailing Address - Country:US
Mailing Address - Phone:561-670-8825
Mailing Address - Fax:
Practice Address - Street 1:3354 SW MARTIN ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-4915
Practice Address - Country:US
Practice Address - Phone:561-670-8825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15317101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor