Provider Demographics
NPI:1750665741
Name:LOVELACE, SCOTT ALFRED (MED, LCMHC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ALFRED
Last Name:LOVELACE
Suffix:
Gender:M
Credentials:MED, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N 25 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-3830
Mailing Address - Country:US
Mailing Address - Phone:801-319-8841
Mailing Address - Fax:
Practice Address - Street 1:720 N 25 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-3830
Practice Address - Country:US
Practice Address - Phone:801-319-8841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6384233-6004101Y00000X, 101YM0800X, 101YP2500X
OK4670101YP2500X
TX65180102L00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst