Provider Demographics
NPI:1861424962
Name:LOOMIS, THOMAS P (PHD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:LOOMIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY159103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI05695701Medicaid
HI05695701Medicaid
HI6552-4Medicare UPIN
HI51492Medicare ID - Type UnspecifiedGROUP #51491