Provider Demographics
NPI:1306029392
Name:JOHN LOVERN, LCSW, LLC
Entity Type:Organization
Organization Name:JOHN LOVERN, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:LOVERN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:504-616-4064
Mailing Address - Street 1:68164 MARION ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-7822
Mailing Address - Country:US
Mailing Address - Phone:504-616-4064
Mailing Address - Fax:985-892-3999
Practice Address - Street 1:1186 FREMAUX AVE
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-3538
Practice Address - Country:US
Practice Address - Phone:985-643-5145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3267261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health