1366504367 NPI number — MS. DEBRA JEAN LOVELESS ED.S, LMHP

Table of content: MS. DEBRA JEAN LOVELESS ED.S, LMHP (NPI 1366504367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366504367 NPI number — MS. DEBRA JEAN LOVELESS ED.S, LMHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOVELESS
Provider First Name:
DEBRA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ED.S, LMHP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366504367
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
POB 214
Provider Second Line Business Mailing Address:
1023 10TH AVENUE
Provider Business Mailing Address City Name:
SIDNEY
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-254-0737
Provider Business Mailing Address Fax Number:
308-254-6375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1023 10TH AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIDNEY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-254-0737
Provider Business Practice Location Address Fax Number:
308-254-6375
Provider Enumeration Date:
12/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  3260 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 151493 . This is a "MID AMERICA BENEFITS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 254111 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10025227700 . This is a "CHILD WELFARE HEALTH AND HUMAN SERVICES" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 254111 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 84018 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 100252227700 . This is a "MAGELLAN BEHAVIORAL HEALTH SERVICES" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10025227700 . This is a "HEALTH AND HUMAN SERVICES" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 254111 . This is a "AETNA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 412053215002 . This is a "COVENTRY" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10025227700 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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