Healthcare Provider Details

I. General information

NPI: 1245028265
Provider Name (Legal Business Name): NATHANIEL JAMES LOVATO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 E DICKENSON PL
DENVER CO
80222-6012
US

IV. Provider business mailing address

4905 W 34TH AVE
DENVER CO
80212-1830
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-6565
  • Fax:
Mailing address:
  • Phone: 720-341-9231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0025162
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: