Provider Demographics
NPI:1417926619
Name:LOVELAND, WILLIAM G (LCSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:G
Last Name:LOVELAND
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1136
Mailing Address - Country:US
Mailing Address - Phone:217-245-7275
Mailing Address - Fax:217-245-7427
Practice Address - Street 1:1515 W WALNUT ST STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-1159
Practice Address - Country:US
Practice Address - Phone:217-245-7275
Practice Address - Fax:217-245-7427
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490070511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8415589OtherBLUE CROSS BLUE SHIELD
IL389251Medicare ID - Type Unspecified