1164425674 NPI number — MS. MONA HELENE LOESER LCSW

Table of content: MS. MONA HELENE LOESER LCSW (NPI 1164425674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164425674 NPI number — MS. MONA HELENE LOESER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOESER
Provider First Name:
MONA
Provider Middle Name:
HELENE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164425674
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 HILLCREST RD
Provider Second Line Business Mailing Address:
APT 312
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36695-3959
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-634-3282
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
578 AZALEA RD
Provider Second Line Business Practice Location Address:
STE 118
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36609-1551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-643-1770
Provider Business Practice Location Address Fax Number:
251-643-1768
Provider Enumeration Date:
05/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  PIP370-1246C , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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