Provider Demographics
NPI:1528567476
Name:MATTIS, LOUIS WADSWORTH II (LMFT)
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:WADSWORTH
Last Name:MATTIS
Suffix:II
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9045 FOREST CENTRE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7857
Mailing Address - Country:US
Mailing Address - Phone:901-756-5788
Mailing Address - Fax:
Practice Address - Street 1:9045 FOREST CENTRE DR STE 102
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-7857
Practice Address - Country:US
Practice Address - Phone:901-756-5788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1279106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist