Provider Demographics
NPI:1467016683
Name:LOVELL MENTAL HEALTH
Entity Type:Organization
Organization Name:LOVELL MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FNP-PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:WICKHAM
Authorized Official - Last Name:SAWITKE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-PMHNP
Authorized Official - Phone:406-396-3100
Mailing Address - Street 1:841 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-3211
Mailing Address - Country:US
Mailing Address - Phone:406-396-3100
Mailing Address - Fax:
Practice Address - Street 1:841 E CENTER ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-3211
Practice Address - Country:US
Practice Address - Phone:406-396-3100
Practice Address - Fax:406-925-5041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTMW2132063OtherDEA