Provider Demographics
NPI:1467059907
Name:LOVELL, TONI (MSW, LCSW, LCAC)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:LOVELL
Suffix:
Gender:F
Credentials:MSW, LCSW, LCAC
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 E LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-3139
Mailing Address - Country:US
Mailing Address - Phone:260-426-3347
Mailing Address - Fax:
Practice Address - Street 1:333 E LEWIS ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-3139
Practice Address - Country:US
Practice Address - Phone:260-426-3347
Practice Address - Fax:260-424-2248
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000689A101YA0400X
IN34004675A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1861636136Medicaid