Healthcare Provider Details

I. General information

NPI: 1396179644
Provider Name (Legal Business Name): CASEY JAMES LOEBS CADC-CAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E WALNUT ST STE 120
PASADENA CA
91101-1554
US

IV. Provider business mailing address

221 E WALNUT ST STE 120
PASADENA CA
91101-1554
US

V. Phone/Fax

Practice location:
  • Phone: 626-802-8287
  • Fax:
Mailing address:
  • Phone: 626-802-8287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number09-4020
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: