Provider Demographics
NPI:1912924812
Name:LOUH, ROXANNE (PHD)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:LOUH
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 1:3527 HENDRICKS AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-5309
Mailing Address - Country:US
Mailing Address - Phone:904-318-9418
Mailing Address - Fax:904-399-1547
Practice Address - Street 1:3527 HENDRICKS AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-5309
Practice Address - Country:US
Practice Address - Phone:904-318-9418
Practice Address - Fax:904-399-1547
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist