Provider Demographics
NPI:1083716575
Name:LOVEJOY, GARY DOUGLAS (PHD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:DOUGLAS
Last Name:LOVEJOY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 S LAKESHORE DR STE 415
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7056
Mailing Address - Country:US
Mailing Address - Phone:480-756-1669
Mailing Address - Fax:480-756-2132
Practice Address - Street 1:4500 S LAKESHORE DR STE 415
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7056
Practice Address - Country:US
Practice Address - Phone:480-756-1669
Practice Address - Fax:480-756-2132
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ795103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0134480OtherBLUE CROSS/BLUE SHIELD
AZPHD795Medicare ID - Type Unspecified
AZAZ0134480OtherBLUE CROSS/BLUE SHIELD