Provider Demographics
NPI:1639353055
Name:SANDRA LOUGHLIN, PH.D., P.C.
Entity Type:Organization
Organization Name:SANDRA LOUGHLIN, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-746-4743
Mailing Address - Street 1:6405 N COSBY AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2378
Mailing Address - Country:US
Mailing Address - Phone:816-746-4743
Mailing Address - Fax:816-746-4753
Practice Address - Street 1:6405 N COSBY AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2378
Practice Address - Country:US
Practice Address - Phone:816-746-4743
Practice Address - Fax:816-746-4753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01421103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0002248Medicare PIN