Provider Demographics
NPI:1043571003
Name:LOOBY, MARY ANN (LSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:LOOBY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:SHEPPHIRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81602-0040
Mailing Address - Country:US
Mailing Address - Phone:970-945-2241
Mailing Address - Fax:970-945-5523
Practice Address - Street 1:360 PEAK ONE DR
Practice Address - Street 2:STE 110
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-3478
Practice Address - Fax:970-668-0632
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1124104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker