Provider Demographics
NPI:1659549962
Name:LOVELL, GUY ELLIOT SR
Entity Type:Individual
Prefix:MR
First Name:GUY
Middle Name:ELLIOT
Last Name:LOVELL
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BEACHWAY DRIVE
Mailing Address - Street 2:SUITE C SUPPORTIVE SYSTEMS LLC
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224
Mailing Address - Country:US
Mailing Address - Phone:317-788-4111
Mailing Address - Fax:317-788-7783
Practice Address - Street 1:25 BEACHWAY DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224
Practice Address - Country:US
Practice Address - Phone:317-788-4111
Practice Address - Fax:317-788-7783
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000330A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical