Basic Information
| Provider Information | |||||||||
| NPI: | 1699814947 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOVETT | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 N REDWOOD LN | ||||||||
| Address2: | |||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473043845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656351982 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3700 W KILGORE AVE | ||||||||
| Address2: | |||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473044810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652895437 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 277275 | 01 | IN | COMP CARE | OTHER | 600017636 | 01 | IN | MAGELLAN | OTHER |