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NPI Code Detail

MEDICARE: MS. KIMBERLY LINCOLN LOVELACE LPC

MEDICARE: MS. KIMBERLY LINCOLN LOVELACE 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
1101YM0800XMental Health Counselor79524TX

General Provider Information

NPI Number : 1598489171
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KIMBERLY LINCOLN LOVELACE LPC
Provider Business Mailing Address
First Line : 1220 HAWTHORNE AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-1919
Country : US
Telephone Number : 817-683-7982
Fax Number :
Provider Business Practice Location Address
First Line : 1220 HAWTHORNE AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-1919
Country : US
Telephone Number : 817-683-7982
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2022
Last Update Date : 09/28/2022

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