Individual
MARTHA E LOOMIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MFTA
Contact information
Practice address
237 E 6TH ST, RUSSELLVILLE, KY 42276-1917
(270) 726-3629
Mailing address
237 E 6TH ST, RUSSELLVILLE, KY 42276-1917
(270) 726-3629
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
08-040
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30604011
—
KY
Enumeration date
01/20/2009
Last updated
01/20/2009
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