Provider Demographics
NPI:1457346983
Name:LOUGHEAD, MICHAEL R (MS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:LOUGHEAD
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1073 WOODHILL DR
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-9271
Mailing Address - Country:US
Mailing Address - Phone:724-272-6031
Mailing Address - Fax:
Practice Address - Street 1:1073 WOODHILL DR
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-9271
Practice Address - Country:US
Practice Address - Phone:724-272-6031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007333L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50880OtherBCBS