Provider Demographics
NPI:1124429527
Name:LOUIS, MAUDE LINE (MED, CMHP)
Entity type:Individual
Prefix:MS
First Name:MAUDE
Middle Name:LINE
Last Name:LOUIS
Suffix:
Gender:F
Credentials:MED, CMHP
Other - Prefix:MS
Other - First Name:MAUDE
Other - Middle Name:LINE
Other - Last Name:ELIASSAINT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, CMHP
Mailing Address - Street 1:3432 MEADOW BREEZE LOOP
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4479
Mailing Address - Country:US
Mailing Address - Phone:772-209-2106
Mailing Address - Fax:
Practice Address - Street 1:3432 MEADOW BREEZE LOOP
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4479
Practice Address - Country:US
Practice Address - Phone:772-209-2106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor