Healthcare Provider Details

I. General information

NPI: 1609122902
Provider Name (Legal Business Name): REGINA LOVELACE B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 NW EXPRESSWAY SUITE 200
OKLAHOMA CITY OK
73132-1534
US

IV. Provider business mailing address

8648 E PARKRIDGE DR
OKLAHOMA CITY OK
73141-2238
US

V. Phone/Fax

Practice location:
  • Phone: 405-525-0452
  • Fax: 405-525-0515
Mailing address:
  • Phone: 405-769-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: