Provider Demographics
NPI:1720400104
Name:LOVEJOY, LARK (MS)
Entity Type:Individual
Prefix:
First Name:LARK
Middle Name:
Last Name:LOVEJOY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LARK
Other - Middle Name:
Other - Last Name:MOBLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 755
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-0755
Mailing Address - Country:US
Mailing Address - Phone:541-708-2024
Mailing Address - Fax:
Practice Address - Street 1:258 A ST
Practice Address - Street 2:SUITE 20
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1947
Practice Address - Country:US
Practice Address - Phone:541-708-2024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3649101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health