Provider Demographics
NPI:1467012252
Name:LOVATO, PAUL SHELDON (BS CACIII)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:SHELDON
Last Name:LOVATO
Suffix:
Gender:M
Credentials:BS CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7114 W JEFFERSON AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-2309
Mailing Address - Country:US
Mailing Address - Phone:303-520-5092
Mailing Address - Fax:
Practice Address - Street 1:1633 FILLMORE ST STE GL5
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1547
Practice Address - Country:US
Practice Address - Phone:720-699-7737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7207101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1902372378OtherPRIVATE INSURANCE