Provider Demographics
NPI:1356422976
Name:PRIVETTE, LOUISE JUDITH (NCSP)
Entity type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:JUDITH
Last Name:PRIVETTE
Suffix:
Gender:F
Credentials:NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11387 S HOPI DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-5437
Mailing Address - Country:US
Mailing Address - Phone:623-932-7500
Mailing Address - Fax:
Practice Address - Street 1:14802 W WIGWAM BLVD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-8231
Practice Address - Country:US
Practice Address - Phone:623-932-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool