Provider Demographics
NPI:1609298744
Name:LOFTIS, MAUREEN (MA, JD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:LOFTIS
Suffix:
Gender:F
Credentials:MA, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1709
Mailing Address - Street 2:
Mailing Address - City:TAHOE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:96145-1709
Mailing Address - Country:US
Mailing Address - Phone:530-386-7992
Mailing Address - Fax:
Practice Address - Street 1:3080 NORTH LAKE BLVD.
Practice Address - Street 2:SUITE 2B
Practice Address - City:TAHOE CITY
Practice Address - State:CA
Practice Address - Zip Code:96145
Practice Address - Country:US
Practice Address - Phone:530-386-7992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC53707106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist