Provider Demographics
NPI:1417175118
Name:LOOPER, MARY FRANCIS
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:FRANCIS
Last Name:LOOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 FLOWER ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95215-6035
Mailing Address - Country:US
Mailing Address - Phone:209-462-8855
Mailing Address - Fax:
Practice Address - Street 1:1839 S EL DORADO ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-2025
Practice Address - Country:US
Practice Address - Phone:209-463-0872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)