Provider Demographics
NPI:1548325806
Name:LOOS, KENNETH ELWOOD JR (MS LMLP LCP)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:ELWOOD
Last Name:LOOS
Suffix:JR
Gender:M
Credentials:MS LMLP LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1374
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601
Mailing Address - Country:US
Mailing Address - Phone:785-628-1642
Mailing Address - Fax:
Practice Address - Street 1:208 E 7TH STR
Practice Address - Street 2:HIGH PLAINS MHC
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601
Practice Address - Country:US
Practice Address - Phone:785-628-2871
Practice Address - Fax:785-628-1438
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMLP 0405103T00000X
KSLCP 242103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist