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General NPI Number Information
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NPI Number | 1801103866
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Entity Type | Organization
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Legal Business Name | ROXANNE LOUH PA INC
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Dates
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Enumeration Date | 09/10/2010
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Last Update Date | 05/07/2019
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Provider Practice Location Address
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Address Line | 3527 HENDRICKS AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32207
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Country | US
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Telephone | 904-318-9418
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Fax |
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Provider Business Mailing Address
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Address Line | 4578 CARRARA CT
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City | JACKSONVILLE
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State | FL
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Zip | 32224-3613
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Country | US
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Telephone | 904-318-9418
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. ROXANNE LOUH
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Credential | PSYD
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Telephone | 904-318-9418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY7400
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License Number State | FL
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