Provider Demographics
NPI:1447831912
Name:LOOMIS, NATALIE (PHD)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:LOOMIS
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 1:1515 E MISSOURI AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2443
Mailing Address - Country:US
Mailing Address - Phone:602-274-1462
Mailing Address - Fax:
Practice Address - Street 1:1515 E MISSOURI AVE STE 110
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2443
Practice Address - Country:US
Practice Address - Phone:602-274-1462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005134103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist