Provider Demographics
NPI:1821475658
Name:LOVELACE, KEVIN BOYD (BCBA)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:BOYD
Last Name:LOVELACE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1129 S LARK ELLEN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-3530
Mailing Address - Country:US
Mailing Address - Phone:626-251-7537
Mailing Address - Fax:
Practice Address - Street 1:99 PASADENA AVE STE 10C
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-6142
Practice Address - Country:US
Practice Address - Phone:619-560-5481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-17541103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst