Provider Demographics
NPI:1679153845
Name:LOVKVIST, JAN MIKAEL TOMAS
Entity Type:Individual
Prefix:DR
First Name:JAN MIKAEL
Middle Name:TOMAS
Last Name:LOVKVIST
Suffix:
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 1:1820 PRESTON PARK BLVD STE 2200
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3614
Mailing Address - Country:US
Mailing Address - Phone:469-551-4967
Mailing Address - Fax:281-599-3777
Practice Address - Street 1:1820 PRESTON PARK BLVD STE 2200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3614
Practice Address - Country:US
Practice Address - Phone:469-551-4967
Practice Address - Fax:281-599-3777
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
TX78863101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health