Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 5339 | MN |
NPI | 1104115955 |
---|---|
Provider Name | Dr. Steven Vincent Loos |
First Address | Saint Cloud, MN 56303-2613 |
Second Address | Saint Cloud, MN 56303-2613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2011 |
Last Update Date | 17/08/2011 |