Healthcare Provider Details

I. General information

NPI: 1104949700
Provider Name (Legal Business Name): JANET B. LOVELAND LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 PARK AVE UNIT 3 SUITE 12
BURLEY ID
83318-2170
US

IV. Provider business mailing address

PO BOX 111
ALBION ID
83311-0111
US

V. Phone/Fax

Practice location:
  • Phone: 208-312-2510
  • Fax: 208-678-3556
Mailing address:
  • Phone: 208-312-2510
  • Fax: 208-678-3556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC-3745
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: