Provider Demographics
NPI:1780728816
Name:MONAHAN, LOUISE (MFT)
Entity type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26883 TOYON LN
Mailing Address - Street 2:
Mailing Address - City:CLOVERDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95425-4321
Mailing Address - Country:US
Mailing Address - Phone:707-894-5112
Mailing Address - Fax:707-894-9015
Practice Address - Street 1:109 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:CLOVERDALE
Practice Address - State:CA
Practice Address - Zip Code:95425-4321
Practice Address - Country:US
Practice Address - Phone:707-894-9012
Practice Address - Fax:707-894-9015
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT20256106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist