Provider Demographics
NPI:1073655544
Name:J&P LOISELLE LLC
Entity type:Organization
Organization Name:J&P LOISELLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:LOISELLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW LISAC
Authorized Official - Phone:520-797-9306
Mailing Address - Street 1:2292 W MAGEE RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742
Mailing Address - Country:US
Mailing Address - Phone:520-797-9306
Mailing Address - Fax:520-544-8312
Practice Address - Street 1:2292 W. MAGEE RD.
Practice Address - Street 2:SUITE 260
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85742-4301
Practice Address - Country:US
Practice Address - Phone:520-797-9306
Practice Address - Fax:520-544-8312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC0936101YA0400X
AZLCSW08121041C0700X
AZLCSW08131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ85038Medicare ID - Type UnspecifiedJ&P LOISELLE LLC