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General NPI Number Information
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NPI Number | 1194693952
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Entity Type | Organization
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Legal Business Name | KELLY LOVEJOY, LICENSED CLINICAL SOCIAL WORKER, P.C.
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Dates
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Enumeration Date | 10/24/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 52830 CEDAR CREST DR.
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City | IDYLLWILD
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State | CA
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Zip | 92549
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Country | US
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Telephone | 619-300-5256
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 89
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City | IDYLLWILD
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State | CA
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Zip | 92549-0089
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Country | US
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Telephone | 619-300-5256
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLY LOVEJOY
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Credential | LCSW
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Telephone | 619-300-5256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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