MEDICARE: KRISTIE R LOVEALL M.ED., LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	2007010646	MO
2	101YP2500X	Professional Counselor	2007010646	MO

General Provider Information

NPI Number	:	1063648335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIE R LOVEALL M.ED., LPC

Provider Business Mailing Address
First Line	:	1703 TIDEWATER DR
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65202-6423
Country	:	US
Telephone Number	:	573-289-7526
Fax Number	:

Provider Business Practice Location Address
First Line	:	63 OLD 63 N.
Second Line	:	STE 105
City	:	COLUMBIA
State	:	MO
Zip	:	65202-3900
Country	:	US
Telephone Number	:	573-499-0011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2009
Last Update Date	:	04/17/2014

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