Healthcare Provider Details

I. General information

NPI: 1447249644
Provider Name (Legal Business Name): KENNETH WAYNE LOVELETT JR. LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MARBLE
ALBUQUERQUE NM
87151-0001
US

IV. Provider business mailing address

11704 TERRA BELLA LN SE
ALBUQUERQUE NM
87123-4527
US

V. Phone/Fax

Practice location:
  • Phone: 505-839-8839
  • Fax:
Mailing address:
  • Phone: 505-296-3679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number68292
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number068292
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: