Healthcare Provider Details

I. General information

NPI: 1154938017
Provider Name (Legal Business Name): BRIAN LOVELESS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 SCHRADER BLVD
LOS ANGELES CA
90028-6213
US

IV. Provider business mailing address

649 WESTBOURNE DR APT 104
WEST HOLLYWOOD CA
90069-5129
US

V. Phone/Fax

Practice location:
  • Phone: 323-993-7446
  • Fax:
Mailing address:
  • Phone: 716-628-9533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number142523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: