Loose Cannon Social Work, LLC.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

8202232-3501 Issued in UT

Legal business name

LOOSE CANNON SOCIAL WORK, LLC.

Practice address

616 S River Rd
#220
St George, UT 84790-2104

Phone

(435) 359-9042

NPI assigned

Oct 26, 2016

Last updated

Oct 26, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Bruce Craig Solomon, LCSW

Title

Managing Partner

Phone

(801) 359-9042

Specialties & licenses 1

Addresses

Other names 1

• Bruce C. Solomon Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1477440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477440000000",
    "number": "1609328525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2298 E 200 S",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847901603",
            "telephone_number": "435-359-9043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 S RIVER RD",
            "address_2": "#220",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847902104",
            "telephone_number": "435-359-9042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOOSE CANNON SOCIAL WORK, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-26",
        "last_updated": "2016-10-26",
        "status": "A",
        "authorized_official_last_name": "SOLOMON",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "CRAIG",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "801-359-9042",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "8202232-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bruce C. Solomon",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Battista Trevor Locatelli
• Adam Jeffrey Lofgran, O.D.
• Amelia Long
• Katie Long
• Sophie Longson
• Loose Cannon Social Work, LLC.
• Abril Lopez Gonzalez
• Abigail Lopez
• Chalyse Lopez
• Madison Lopez

• Mental Health Counselor in St George, UT
• Providers in St George, UT by specialty
• Mental Health Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.