Provider Demographics
NPI:1891703658
Name:LOOMIS, LYNN GROFF (MED LPC)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:GROFF
Last Name:LOOMIS
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:LYNN
Other - Last Name:GROFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4237 ORCHARD HILL RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3327
Mailing Address - Country:US
Mailing Address - Phone:717-233-0996
Mailing Address - Fax:
Practice Address - Street 1:3235 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1308
Practice Address - Country:US
Practice Address - Phone:717-234-3839
Practice Address - Fax:717-234-6247
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03242801OtherCAPITAL BLUE CROSS