Provider Demographics
NPI:1841424298
Name:LOVELL, TOBIN RYAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TOBIN
Middle Name:RYAN
Last Name:LOVELL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 ETIWAN AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-4336
Mailing Address - Country:US
Mailing Address - Phone:803-727-4149
Mailing Address - Fax:
Practice Address - Street 1:901 SUMTER ST
Practice Address - Street 2:BYRNES BUILDING, 7TH FLOOR
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29208-0001
Practice Address - Country:US
Practice Address - Phone:803-777-5223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1041103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist