Provider Demographics
NPI:1689431066
Name:LOVELY, JOHN DAVID (LPC-MHSP (TEMP))
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:LOVELY
Suffix:
Gender:M
Credentials:LPC-MHSP (TEMP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 DEER RUN CV
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:TN
Mailing Address - Zip Code:38063-2087
Mailing Address - Country:US
Mailing Address - Phone:901-482-1347
Mailing Address - Fax:
Practice Address - Street 1:310 DEER RUN CV
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:TN
Practice Address - Zip Code:38063-2087
Practice Address - Country:US
Practice Address - Phone:901-482-1347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6707101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional