Provider Demographics
NPI:1912395500
Name:LOFTUS, JOANNA
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:LOFTUS
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 1:911 PORTLAND PL
Mailing Address - Street 2:APT 5
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3381
Mailing Address - Country:US
Mailing Address - Phone:917-715-6915
Mailing Address - Fax:
Practice Address - Street 1:911 PORTLAND PL
Practice Address - Street 2:APT5
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3381
Practice Address - Country:US
Practice Address - Phone:917-715-6915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0104996101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor