Provider Demographics
NPI:1184170698
Name:NEALON, LOUIS DAVID (BA, MA, MFTI)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:DAVID
Last Name:NEALON
Suffix:
Gender:M
Credentials:BA, MA, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17822 BEACH BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7192
Mailing Address - Country:US
Mailing Address - Phone:657-203-3228
Mailing Address - Fax:
Practice Address - Street 1:17822 BEACH BLVD STE 230
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7192
Practice Address - Country:US
Practice Address - Phone:657-203-3228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-26
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83141106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist