Provider Demographics
NPI:1891165650
Name:LO, ARDIS
Entity type:Individual
Prefix:
First Name:ARDIS
Middle Name:
Last Name:LO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E LOUISIANA ST
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-4471
Mailing Address - Country:US
Mailing Address - Phone:469-207-1548
Mailing Address - Fax:469-342-8106
Practice Address - Street 1:114 E LOUISIANA ST
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-4471
Practice Address - Country:US
Practice Address - Phone:469-207-1548
Practice Address - Fax:469-342-8106
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70713101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health