Provider Demographics
NPI:1154847689
Name:LOVELESS, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:LOVELESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 WARM SPRINGS ROAD
Mailing Address - Street 2:APARTMENT 921
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014
Mailing Address - Country:US
Mailing Address - Phone:219-718-9034
Mailing Address - Fax:
Practice Address - Street 1:3001 W WARM SPRINGS RD APT 921
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-4577
Practice Address - Country:US
Practice Address - Phone:219-718-9034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst