Provider Demographics
NPI:1366874224
Name:LOOZE, JORDAN (LPC)
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:
Last Name:LOOZE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4948 W KOOTENAI ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-2080
Mailing Address - Country:US
Mailing Address - Phone:208-371-4548
Mailing Address - Fax:
Practice Address - Street 1:4948 W KOOTENAI ST
Practice Address - Street 2:SUITE 207
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2080
Practice Address - Country:US
Practice Address - Phone:208-371-4548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5280101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health