Healthcare Provider Details

I. General information

NPI: 1437420312
Provider Name (Legal Business Name): CHRISTA ANN LOVELAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 NE ROBERTS AVE STE 350
GRESHAM OR
97030-7486
US

IV. Provider business mailing address

PO BOX 1813
GRESHAM OR
97030-0545
US

V. Phone/Fax

Practice location:
  • Phone: 503-512-8526
  • Fax:
Mailing address:
  • Phone: 503-922-5950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: