Provider Demographics
NPI:1245521418
Name:LOUIS DESONIER, PHD PA
Entity type:Organization
Organization Name:LOUIS DESONIER, PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF PA
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:GONZARA
Authorized Official - Last Name:DESONIER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:850-444-7054
Mailing Address - Street 1:1717 NORTH 'E' ST SUITE 303
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-6339
Mailing Address - Country:US
Mailing Address - Phone:850-444-7054
Mailing Address - Fax:850-434-8210
Practice Address - Street 1:1717 NORTH 'E' ST. SUITE 303
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6339
Practice Address - Country:US
Practice Address - Phone:850-444-7054
Practice Address - Fax:850-434-8210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3062103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty