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General NPI Number Information
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NPI Number | 1992174189
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Entity Type | Individual
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Provider Name | MARK ALAN LOOMIS LPC
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Gender | Male
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 2680 W MARKET ST
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City | FAIRLAWN
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State | OH
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Zip | 44333-4215
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Country | US
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Telephone | 234-867-5001
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Fax | 234-867-5002
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Provider Business Mailing Address
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Address Line | 731 BEECHWOOD DR
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City | MEDINA
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State | OH
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Zip | 44256-1603
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Country | US
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Telephone | 330-321-9470
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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 | E.1700362
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License Number State | OH
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