Provider Demographics
NPI:1730363235
Name:LOO, BENG (CDP)
Entity type:Individual
Prefix:
First Name:BENG
Middle Name:
Last Name:LOO
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:VICTOR
Other - Middle Name:
Other - Last Name:LOO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1433 12TH AVE
Mailing Address - Street 2:APT 208
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122
Mailing Address - Country:US
Mailing Address - Phone:206-769-5545
Mailing Address - Fax:
Practice Address - Street 1:720 8TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3032
Practice Address - Country:US
Practice Address - Phone:206-695-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP0004902101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)