Healthcare Provider Details

I. General information

NPI: 1790555456
Provider Name (Legal Business Name): MICHAEL NORMAN LOVATO MA, LMHC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 SUNWEST DR SW
ALBUQUERQUE NM
87121-9433
US

IV. Provider business mailing address

809 SUNWEST DR SW
ALBUQUERQUE NM
87121-9433
US

V. Phone/Fax

Practice location:
  • Phone: 505-366-1898
  • Fax:
Mailing address:
  • Phone: 505-366-1898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2023-0937
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: