LOOSE CANNON SOCIAL WORK, LLC. (NPI# 1609328525) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609328525 |
| Entity Type | Organization |
| Organization Name | LOOSE CANNON SOCIAL WORK, LLC. |
| Other Organization Name | BRUCE C. SOLOMON |
| Practice Address |
616 S River Rd #220 St George UT 84790-2104 |
| Mailing Address |
2298 E 200 S St George UT 84790-1603 |
| Practice Telephone | 4353599042 |
| Mailing Telephone | 4353599043 |
| Enumeration Date | 2016-10-26 |
| Last Update Date | 2016-10-26 |
| Authorized Official Name | MR. BRUCE CRAIG SOLOMON (MANAGING PARTNER) |
| Authorized Official Telephone | 8013599042 |
| Authorized Official Credential | LCSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
8202232-3501 | UT | Behavioral Health & Social Service Providers |
| Other Name | Type Code |
|---|---|
| Bruce C. Solomon | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811447725 | Loose Cannon Social Work, LLC. | Exclusive Provider Organization | 2298 E 200 S, Saint George, UT 84790-1603 | 2016-10-04 |
| Street Address |
616 S RIVER RD #220 |
| City | ST GEORGE |
| State | UT |
| Zip Code | 84790-2104 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801037684 | Barbara Marshall | Audiologist-Hearing Aid Fitter | 616 S River Rd, Ste. 210, St George, UT 84790-2104 | 2009-03-09 |
| 1710343629 | Integrated Senior Care Personal Care | In Home Supportive Care | 616 S River Rd, 200, St George, UT 84790-2104 | 2016-01-07 |
| 1407268485 | Integrated Senior Care Hospice | Hospice Care, Community Based | 616 S River Rd, Suite 200, St George, UT 84790 | 2014-05-27 |
| 1922420827 | Ideal Hearing Solutions LLC | Hearing Instrument Specialist | 616 S River Rd, Suite 210, St George, UT 84790-2104 | 2014-01-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396342713 | Katrina Poulsen | Student in an Organized Health Care Education/Training Program | 617 East Rriverside Dr, Ste 301, St. George, UT 84790 | 2020-10-08 |
| 1124643226 | Desert View Eyecare | Optometrist | 15 South River Road St. 150, St. George, UT 84790 | 2020-06-15 |
| 1366066417 | Benjamin Todd Lloyd | Dentist | 1683 E. Wolf Hole Dr, St. George, UT 84790 | 2020-06-04 |
| 1801434584 | Jennifer M Putnam | Marriage & Family Therapist | 321 North Mall Drive, Vw103, St. George, UT 84790 | 2019-12-12 |
| 1326683012 | Red Mountain Counseling and Education | Counselor | 321 No Mall Dr, Vw 103, St. George, UT 84790 | 2019-11-17 |
| 1295376002 | Karynne Kimberly Simpson | Behavior Technician | 280 N 1680 E U1, St. George, UT 84790 | 2019-10-02 |
| 1962053017 | Mikala Larsen | Nurse Practitioner | 1380 S Medical Center Dr., Saint George, UT 84790 | 2019-09-20 |
| 1326690678 | Joe Ballent | Student in an Organized Health Care Education/Training Program | 1526 S Medical Center Dr Ste 224a, St George, UT 84790 | 2019-07-16 |
| 1558923854 | David Pace | Optometrist | 749 South River Rd, St. George, UT 84790 | 2019-07-08 |
| 1639734924 | Mariah Ann Mertlich | Behavioral Analyst | 280 N 1680 E, U1, St. George, UT 84790 | 2019-05-02 |
| Find all providers in zip 84790 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104437623 | Counseling for Success Inc | Counselor | 166 N 300 W Ste 4, St George, UT 84770-2770 | 2020-08-10 |
| 1881215291 | Laura Helquist | Counselor | 321 N Mall Dr # 0-101, St George, UT 84790-7302 | 2020-04-27 |
| 1952861841 | Billie Jene Authement Acheson | Counselor | 620 S 400 E Ste 404, St George, UT 84770-7065 | 2019-03-25 |
| 1801352380 | Brayden Sloan | Counselor | 225 N Country Ln Unit 55, St George, UT 84770-8458 | 2019-02-20 |
| 1578095683 | Leigh Ann Stambaugh | Counselor | 1031 S Bluff St # 130, St George, UT 84770-5206 | 2017-03-28 |
| 1093252348 | Kathryn G Price Lcmhc LLC | Counselor | 292 S 1470 E, St George, UT 84790-1763 | 2017-01-25 |
| 1659825271 | Connie Hanson | Counselor | 230 N 1680 E Ste T2, St George, UT 84790-2573 | 2016-08-11 |
| 1063880839 | Colby Gannon Backman | Counselor | 301 N 200 E Ste 2c, St George, UT 84770-3040 | 2015-09-09 |
| 1306255435 | Tracy Davis | Counselor | 638 E 3470 S, St George, UT 84790-6246 | 2014-08-02 |
| 1053733949 | Erin Boorman | Counselor | 1240 E 100 S Ste 121, St George, UT 84790-3079 | 2014-01-10 |
| Find all providers in ST GEORGE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.