Provider Demographics
NPI:1871148304
Name:LOONEY, CARLA (BSW)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:LOONEY
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 FAIRGROUND AVE
Mailing Address - Street 2:
Mailing Address - City:HIGGINSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64037-1711
Mailing Address - Country:US
Mailing Address - Phone:660-229-0655
Mailing Address - Fax:
Practice Address - Street 1:525 FAIRGROUND AVE
Practice Address - Street 2:
Practice Address - City:HIGGINSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64037-1711
Practice Address - Country:US
Practice Address - Phone:660-229-0655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities