Provider Demographics
NPI:1942306543
Name:LOAR, JEAN ANN (LCSW-ACP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:ANN
Last Name:LOAR
Suffix:
Gender:F
Credentials:LCSW-ACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 N JOSEY LN
Mailing Address - Street 2:SUITE 213
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-3159
Mailing Address - Country:US
Mailing Address - Phone:972-492-6681
Mailing Address - Fax:972-492-6583
Practice Address - Street 1:3630 N JOSEY LN
Practice Address - Street 2:SUITE 213
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-3159
Practice Address - Country:US
Practice Address - Phone:972-492-6681
Practice Address - Fax:972-492-6583
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS123691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS04NMedicare ID - Type UnspecifiedMEDICARE