Provider Demographics
NPI:1265815559
Name:MCDERMOTT, LOUISE (MA, LPC)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3413 GABLE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-3011
Mailing Address - Country:US
Mailing Address - Phone:512-659-3528
Mailing Address - Fax:
Practice Address - Street 1:4413 SPICEWOOD SPRINGS RD
Practice Address - Street 2:SUITE 111
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8580
Practice Address - Country:US
Practice Address - Phone:512-659-3528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-04
Last Update Date:2015-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69114101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health