Doctor Name: | CAREN LOOMIS |
NPI Number: | 1174977144 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 530 S Asbury St Suite 2 Moscow, ID - 838432242 |
Business Phone Number: | 2088822566 |
Business Fax Number: | |
Mailing Address: | 530 S Asbury St, Suite 2 MOSCOW |
State: | ID |
Postal Code: | 838432242 |
Phone Number: | 2088822566 |
Fax Number: | |
NPI Enumeration Date: | 04/15/2016 |
NPI Last Update Date: | 04/15/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |