Provider Demographics
NPI:1295203719
Name:LOOMIS, PUI CHUN
Entity Type:Individual
Prefix:
First Name:PUI CHUN
Middle Name:
Last Name:LOOMIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:
Other - Last Name:LOOMIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 N BARRANCA ST # 750
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-1637
Mailing Address - Country:US
Mailing Address - Phone:626-559-0813
Mailing Address - Fax:
Practice Address - Street 1:100 N BARRANCA ST # 750
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1637
Practice Address - Country:US
Practice Address - Phone:626-559-0813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAACSW84905101YM0800X, 104100000X
101YA0400X
CALCSW1116801041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical