MEDICARE: ALISSA MARIE LOOMIS BHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1538002209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISSA MARIE LOOMIS BHT

Provider Business Mailing Address
First Line	:	673 N 6TH DR
Second Line	:
City	:	SHOW LOW
State	:	AZ
Zip	:	85901-4504
Country	:	US
Telephone Number	:	928-242-7694
Fax Number	:

Provider Business Practice Location Address
First Line	:	5171 S CUB LAKE RD
Second Line	:
City	:	SHOW LOW
State	:	AZ
Zip	:	85901-7888
Country	:	US
Telephone Number	:	928-235-0422
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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