Provider Demographics
NPI:1497044796
Name:LOVETT, JEANETTA MAE (BA)
Entity Type:Individual
Prefix:MISS
First Name:JEANETTA
Middle Name:MAE
Last Name:LOVETT
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 NE 83RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-3910
Mailing Address - Country:US
Mailing Address - Phone:405-397-5856
Mailing Address - Fax:
Practice Address - Street 1:712 NE 83RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-3910
Practice Address - Country:US
Practice Address - Phone:405-397-5856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health