Provider Demographics
NPI:1326122664
Name:LOOMIS, KIMBERLY ANN (MA, LMHP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:LOOMIS
Suffix:
Gender:F
Credentials:MA, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 AVENUE I
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4902
Mailing Address - Country:US
Mailing Address - Phone:308-635-3696
Mailing Address - Fax:
Practice Address - Street 1:4215 AVENUE I
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4902
Practice Address - Country:US
Practice Address - Phone:308-635-3696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2328101YM0800X
NE1296101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE348830000OtherMAGELLAN MIS #
NE10025154700Medicaid
NE85246OtherBCBS