Healthcare Provider Details

I. General information

NPI: 1710744156
Provider Name (Legal Business Name): INEZ JOANN LOVATO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: INEZ GURULE

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 NORTHGLEN DR
CLOVIS NM
88101-2935
US

IV. Provider business mailing address

PO BOX 1934
CLOVIS NM
88102-1934
US

V. Phone/Fax

Practice location:
  • Phone: 575-218-9809
  • Fax:
Mailing address:
  • Phone: 575-218-9809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-09010
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: