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General NPI Number Information
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NPI Number | 1992088140
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Entity Type | Individual
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Provider Name | CHERYL EMILY LOOMIS LICSW, LMP
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Gender | Female
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Dates
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Enumeration Date | 09/23/2011
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Last Update Date | 08/28/2014
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Provider Practice Location Address
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Address Line | 2204 PACIFIC AVE N
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City | LONG BEACH
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State | WA
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Zip | 98631-3300
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Country | US
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Telephone | 360-642-3787
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Fax | 360-642-2096
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Provider Business Mailing Address
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Address Line | 2204 PACIFIC AVE N
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City | LONG BEACH
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State | WA
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Zip | 98640-1260
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Country | US
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Telephone | 360-642-8737
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Fax | 360-642-2096
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW 60073162
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA 00010320
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License Number State | WA
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