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General NPI Number Information
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NPI Number | 1245418599
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Entity Type | Individual
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Provider Name | ROBERT WALKER LOOS MS, LPC-MHSP
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Gender | Male
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Dates
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Enumeration Date | 02/07/2008
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Last Update Date | 02/07/2008
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Provider Practice Location Address
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Address Line | 815 MOUNT MORIAH RD
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City | MEMPHIS
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State | TN
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Zip | 38117-5704
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Country | US
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Telephone | 901-685-5491
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Fax | 901-685-8292
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Provider Business Mailing Address
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Address Line | 6977 GALLOP DR
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City | CORDOVA
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State | TN
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Zip | 38018-8866
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Country | US
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Telephone | 901-581-9898
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0000002200
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License Number State | TN
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