Provider Demographics
NPI:1063648335
Name:LOVEALL, KRISTIE R (MED, LPC)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:R
Last Name:LOVEALL
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 TIDEWATER DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-6423
Mailing Address - Country:US
Mailing Address - Phone:573-289-7526
Mailing Address - Fax:
Practice Address - Street 1:63 OLD 63 N.
Practice Address - Street 2:STE 105
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-3900
Practice Address - Country:US
Practice Address - Phone:573-499-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007010646101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health