Provider Demographics
NPI:1598855801
Name:CHIU, LOANNE E (PHD)
Entity Type:Individual
Prefix:DR
First Name:LOANNE
Middle Name:E
Last Name:CHIU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:6320 SOUTHWEST BLVD
Mailing Address - Street 2:CROSSLANDS PLAZA SUITE 113
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109
Mailing Address - Country:US
Mailing Address - Phone:817-335-5300
Mailing Address - Fax:817-735-1574
Practice Address - Street 1:6320 SOUTHWEST BLVD
Practice Address - Street 2:CROSSLANDS PLAZA SUITE 113
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76109-6965
Practice Address - Country:US
Practice Address - Phone:817-335-5300
Practice Address - Fax:817-735-1574
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX2-2079103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXOOPA51Medicare ID - Type Unspecified