MEDICARE: DANA LOVICK

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	101YP2500X	Professional Counselor	2694	OK

General Provider Information

NPI Number	:	1790566826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA LOVICK

Provider Business Mailing Address
First Line	:	11805 BLUE BELL AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-1071
Country	:	US
Telephone Number	:	405-206-2943
Fax Number	:

Provider Business Practice Location Address
First Line	:	4731 JUDY DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73115-3815
Country	:	US
Telephone Number	:	405-856-4217
Fax Number	:

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

Provider Enumeration Date	:	10/13/2023
Last Update Date	:	10/13/2023

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Directions to “ DANA LOVICK ” Practice Location

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