Provider Demographics
NPI:1487332060
Name:LOUVIERE, MADISON WALLER
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:WALLER
Last Name:LOUVIERE
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 1:1800 GOVERNMENT ST
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3931
Mailing Address - Country:US
Mailing Address - Phone:228-351-5833
Mailing Address - Fax:
Practice Address - Street 1:1800 GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3931
Practice Address - Country:US
Practice Address - Phone:228-351-5833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-0959101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health