Healthcare Provider Details

I. General information

NPI: 1235058264
Provider Name (Legal Business Name): RAVIN LOVETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 PLANTATION BLVD
JACKSON MS
39211-2208
US

IV. Provider business mailing address

1755 PLANTATION BLVD
JACKSON MS
39211-2208
US

V. Phone/Fax

Practice location:
  • Phone: 601-594-4097
  • Fax:
Mailing address:
  • Phone: 601-594-4097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: