MEDICARE: ALLEN LOVELACE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist
2	174400000X	Specialist

General Provider Information

NPI Number	:	1144719584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLEN LOVELACE

Provider Business Mailing Address
First Line	:	1515 E BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-1550
Country	:	US
Telephone Number	:	614-623-5510
Fax Number	:

Provider Business Practice Location Address
First Line	:	2246 S HAMILTON RD STE 100
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-4317
Country	:	US
Telephone Number	:	855-519-2787
Fax Number	:	614-868-1690

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2018
Last Update Date	:	11/18/2020

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Directions to “ ALLEN LOVELACE ” Practice Location

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