Healthcare Provider Details

I. General information

NPI: 1316366057
Provider Name (Legal Business Name): TROY J LOOSLE LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 E HIGHLAND AVE B425
PHOENIX AZ
85016-4741
US

IV. Provider business mailing address

10204 BODE ST STE B
PLAINFIELD IL
60585-9813
US

V. Phone/Fax

Practice location:
  • Phone: 602-795-9705
  • Fax: 602-595-2108
Mailing address:
  • Phone: 855-241-7160
  • Fax: 954-324-8354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-17103
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: