Provider Demographics
NPI:1871673285
Name:MOCK, LOU ANN TODD (PHD)
Entity Type:Individual
Prefix:
First Name:LOU ANN
Middle Name:TODD
Last Name:MOCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-4303
Mailing Address - Country:US
Mailing Address - Phone:713-802-3839
Mailing Address - Fax:
Practice Address - Street 1:1807 LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-4303
Practice Address - Country:US
Practice Address - Phone:713-802-3839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-1432103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
F34347Medicare UPIN
81074PMedicare ID - Type Unspecified