Provider Demographics
NPI:1376161489
Name:LOVICK, BRENDA R (MDIV, MA, LMFT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:R
Last Name:LOVICK
Suffix:
Gender:F
Credentials:MDIV, MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 MONONA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3556
Mailing Address - Country:US
Mailing Address - Phone:608-663-0763
Mailing Address - Fax:608-663-0765
Practice Address - Street 1:5900 MONONA DR STE 100
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-3556
Practice Address - Country:US
Practice Address - Phone:608-663-0763
Practice Address - Fax:608-663-0765
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1116-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist