Provider Demographics
NPI:1215601992
Name:LOVATO, MICHAEL (CSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LOVATO
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 BRIGHT STAR DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1300
Mailing Address - Country:US
Mailing Address - Phone:505-907-7376
Mailing Address - Fax:
Practice Address - Street 1:3939 SAN PEDRO DR NE BLDG B1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-8903
Practice Address - Country:US
Practice Address - Phone:505-440-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCSA0218251101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor