Provider Demographics
NPI:1750635181
Name:LOUIS, RICHARD III
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:LOUIS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4929 WILSHIRE BLVD STE 510
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3820
Mailing Address - Country:US
Mailing Address - Phone:310-734-5579
Mailing Address - Fax:310-734-5511
Practice Address - Street 1:4929 WILSHIRE BLVD STE 510
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3820
Practice Address - Country:US
Practice Address - Phone:310-734-5579
Practice Address - Fax:310-734-5511
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty