Provider Demographics
NPI:1972818326
Name:PETTS, LOUANN (MA)
Entity Type:Individual
Prefix:MRS
First Name:LOUANN
Middle Name:
Last Name:PETTS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 EDGEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-3005
Mailing Address - Country:US
Mailing Address - Phone:304-344-4637
Mailing Address - Fax:
Practice Address - Street 1:1003 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-3005
Practice Address - Country:US
Practice Address - Phone:304-344-4637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV985103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist