Healthcare Provider Details

I. General information

NPI: 1750078820
Provider Name (Legal Business Name): JAMIE MARIE LOOR PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 GOLD AVE SW # 256
ALBUQUERQUE NM
87102-3335
US

IV. Provider business mailing address

2131 W REPUBLIC RD PMB 569
SPRINGFIELD MO
65807
US

V. Phone/Fax

Practice location:
  • Phone: 417-501-9423
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-2023-0062
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2023010365
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: