Provider Demographics
NPI:1093952749
Name:LOVEJOY, GARY HAROLD (PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:HAROLD
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 1:12399 SE DEERFIELD PL
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-6700
Mailing Address - Country:US
Mailing Address - Phone:503-698-5243
Mailing Address - Fax:
Practice Address - Street 1:1832 NE 39TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-5301
Practice Address - Country:US
Practice Address - Phone:503-341-5764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCO562101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional