Provider Demographics
NPI:1821295684
Name:MAYHEW, LOU ANN (LICENSEDPSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:LOU ANN
Middle Name:
Last Name:MAYHEW
Suffix:
Gender:F
Credentials:LICENSEDPSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39997 405TH LN
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-4271
Mailing Address - Country:US
Mailing Address - Phone:507-246-5345
Mailing Address - Fax:
Practice Address - Street 1:319 E HICKORY ST
Practice Address - Street 2:HORIZON HOMES, INC. IRTS
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3746
Practice Address - Country:US
Practice Address - Phone:507-344-3367
Practice Address - Fax:507-344-3372
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3797103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist