Provider Demographics
NPI:1811495534
Name:HEAD, LOUISE E (ASSOCIATE MFT)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:E
Last Name:HEAD
Suffix:
Gender:F
Credentials:ASSOCIATE MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 K ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5185
Mailing Address - Country:US
Mailing Address - Phone:530-760-5084
Mailing Address - Fax:
Practice Address - Street 1:2617 K ST STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5185
Practice Address - Country:US
Practice Address - Phone:530-760-5084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-28
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103692106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist