Provider Demographics
NPI:1508646142
Name:LOUDIS, LEA MARIE (RIMFT)
Entity Type:Individual
Prefix:MRS
First Name:LEA
Middle Name:MARIE
Last Name:LOUDIS
Suffix:
Gender:F
Credentials:RIMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 W HILLSBORO BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-8437
Mailing Address - Country:US
Mailing Address - Phone:561-990-4312
Mailing Address - Fax:
Practice Address - Street 1:2501 W HILLSBORO BLVD STE 102
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-8437
Practice Address - Country:US
Practice Address - Phone:561-990-4312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist