Charles Loosemore is a Peer Specialist based in Layton, UT. Charles Loosemore practices in Layton, UT. The NPI Number for Charles Loosemore is 1437616273 and holds a License No. 14249 (Utah).
The current practice location address for Charles Loosemore is 934 S Main St, Layton, UT and can be reached out via phone at 801-773-7060.
Location: 934 S Main St, Layton, UT, 84041-7135
Provider Profile Details
NPI Number
1437616273
Provider Name
Charles Loosemore
Credential
Provider Entity Type
Individual
Gender
Male
Address
934 S Main St, Layton, UT, 84041-7135
Phone Number
801-773-7060
Fax Number
Provider Enumeration Date
02/28/2019
Last Update Date
03/10/2024
Provider's Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000055266 | 01 | UT | MEDICARE PIN |
| 260022408 | 01 | UT | RAILROAD MEDICARE |
| 8760003008007 | 05 | UT |
Provider Business Practice Location Address Details
Address
934 S Main St
City
State
Zip
84041-7135
Phone Number
801-773-7060
Fax Number
Provider Business Mailing Address Details
Address
934 S Main St
City
State
Zip
84041-7135
Phone Number
801-773-7060
Fax Number
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
()
Definition
Definition to come...
Provider's Taxonomy Details 2
Type
Other Service Providers
Classification
Peer Specialist
Speciality
-
Taxonomy
License No.
14249 (California)
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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