Provider Demographics
NPI:1386626877
Name:LOISELLE, PETER (LCSW, LISAC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:LOISELLE
Suffix:
Gender:M
Credentials:LCSW, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8715 N MORNING VIEW DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-4727
Mailing Address - Country:US
Mailing Address - Phone:520-797-8416
Mailing Address - Fax:520-544-8312
Practice Address - Street 1:6812 N ORACLE RD
Practice Address - Street 2:SUITE 114
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4246
Practice Address - Country:US
Practice Address - Phone:520-797-9306
Practice Address - Fax:520-544-8312
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-0936101YA0400X
AZLCSW-08121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ85038Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
AZ85040Medicare ID - Type UnspecifiedPERSONAL MEDICARE NUMBER