Provider Demographics
NPI:1780967752
Name:LOOMIS, ADAM LEE
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:LEE
Last Name:LOOMIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 WILSHIRE BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1688
Mailing Address - Country:US
Mailing Address - Phone:213-413-9122
Mailing Address - Fax:213-413-9132
Practice Address - Street 1:1636 WILSHIRE BLVD FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1688
Practice Address - Country:US
Practice Address - Phone:213-413-9122
Practice Address - Fax:213-413-9132
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)