Provider Demographics
NPI:1316366057
Name:LOOSLE, TROY J (LMSW)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:J
Last Name:LOOSLE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10204 BODE ST STE B
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-9813
Mailing Address - Country:US
Mailing Address - Phone:855-241-7160
Mailing Address - Fax:954-324-8354
Practice Address - Street 1:2111 E HIGHLAND AVE
Practice Address - Street 2:B425
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4741
Practice Address - Country:US
Practice Address - Phone:602-795-9705
Practice Address - Fax:602-595-2108
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-128161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical