Provider Demographics
NPI:1669697520
Name:LOU, MIMI WHEIPING (PHD)
Entity type:Individual
Prefix:DR
First Name:MIMI
Middle Name:WHEIPING
Last Name:LOU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 TELEGRAPH AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1371
Mailing Address - Country:US
Mailing Address - Phone:510-652-5910
Mailing Address - Fax:510-655-1004
Practice Address - Street 1:6355 TELEGRAPH AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1371
Practice Address - Country:US
Practice Address - Phone:510-652-5910
Practice Address - Fax:510-655-1004
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 13923103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical