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General NPI Number Information
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NPI Number | 1104343557
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Entity Type | Individual
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Provider Name | MARIS LOEFFLER MA
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Gender | Female
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Dates
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Enumeration Date | 08/26/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 3875 TAYLOR RD STE 200G
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City | LOOMIS
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State | CA
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Zip | 95650-9242
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Country | US
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Telephone | 530-401-2078
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Fax | 530-401-2078
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Provider Business Mailing Address
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Address Line | 4937 SAINT THOMAS DR
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City | FAIR OAKS
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State | CA
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Zip | 95628-5312
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 94277
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License Number State | CA
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