Healthcare Provider Details

I. General information

NPI: 1902863012
Provider Name (Legal Business Name): SUZANNE LOVELACE L.P.C.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 05/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 EOTOTO RD
EL PRADO NM
87529-7423
US

IV. Provider business mailing address

26 EOTOTO RD
EL PRADO NM
87529-7423
US

V. Phone/Fax

Practice location:
  • Phone: 575-779-4382
  • Fax:
Mailing address:
  • Phone: 575-779-4382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0125121
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: