Healthcare Provider Details

I. General information

NPI: 1215601992
Provider Name (Legal Business Name): MICHAEL LOVATO CSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 MONTGOMERY BLVD NE STE F
ALBUQUERQUE NM
87109-1186
US

IV. Provider business mailing address

3018 BRIGHT STAR DR NW
ALBUQUERQUE NM
87120-1300
US

V. Phone/Fax

Practice location:
  • Phone: 505-301-5297
  • Fax:
Mailing address:
  • Phone: 505-907-7376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCSA0218251
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSWB20240726
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: