Provider Demographics
NPI:1841496411
Name:TOM LOOMIS PH.D., INC.
Entity type:Organization
Organization Name:TOM LOOMIS PH.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WATANABE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:808-949-7759
Mailing Address - Street 1:1481 S KING ST STE 523
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2605
Mailing Address - Country:US
Mailing Address - Phone:808-949-7759
Mailing Address - Fax:808-942-7191
Practice Address - Street 1:1481 S KING ST STE 523
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2605
Practice Address - Country:US
Practice Address - Phone:808-949-7759
Practice Address - Fax:808-942-7191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-159103TC0700X
HILCSW-30521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI51491Medicare ID - Type UnspecifiedGRP PIN #