Provider Demographics
NPI:1558493718
Name:KATTAN, MARIA I (PHD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:I
Last Name:KATTAN
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 1:242 W SHAMROCK. AVE.
Mailing Address - Street 2:
Mailing Address - City:PINEVILLA
Mailing Address - State:LA
Mailing Address - Zip Code:71360
Mailing Address - Country:US
Mailing Address - Phone:318-484-6287
Mailing Address - Fax:
Practice Address - Street 1:242 W SHAMROCK AVE
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-6450
Practice Address - Country:US
Practice Address - Phone:318-484-6287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA623103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1675865Medicaid
LA1675865Medicaid
LAS17571Medicare UPIN