Healthcare Provider Details

I. General information

NPI: 1831214105
Provider Name (Legal Business Name): SANDRA LEE LOVELY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6910 N MAIN ST UNIT 5 BUILDING 12
GRANGER IN
46530-9680
US

IV. Provider business mailing address

4860 ROBB ST SUITE 201
WHEAT RIDGE CO
80033-2184
US

V. Phone/Fax

Practice location:
  • Phone: 574-271-3565
  • Fax:
Mailing address:
  • Phone: 303-278-7418
  • Fax: 888-341-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34001600A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: