Healthcare Provider Details

I. General information

NPI: 1174977144
Provider Name (Legal Business Name): CAREN LOOMIS COX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 S MAIN ST STE 1
MOSCOW ID
83843-2983
US

IV. Provider business mailing address

530 S ASBURY ST SUITE 2
MOSCOW ID
83843-2242
US

V. Phone/Fax

Practice location:
  • Phone: 208-882-2011
  • Fax: 208-883-1853
Mailing address:
  • Phone: 208-882-2566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC-7272
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: