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NPI Code Detail

MEDICARE: MR. KEVIN BOYD LOVELACE BCBA

MEDICARE: MR. KEVIN BOYD LOVELACE BCBA
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
1103K00000XBehavior Analyst1-14-17541CA

General Provider Information

NPI Number : 1821475658
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEVIN BOYD LOVELACE BCBA
Provider Business Mailing Address
First Line : 1129 S LARK ELLEN AVE
Second Line :
City : WEST COVINA
State : CA
Zip : 91791-3530
Country : US
Telephone Number : 626-251-7537
Fax Number :
Provider Business Practice Location Address
First Line : 99 PASADENA AVE STE 10C
Second Line :
City : SOUTH PASADENA
State : CA
Zip : 91030-6142
Country : US
Telephone Number : 619-560-5481
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2015
Last Update Date : 10/03/2023

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