Provider Demographics
NPI:1891186557
Name:LOVETT, MATISSE ROSE
Entity Type:Individual
Prefix:MISS
First Name:MATISSE
Middle Name:ROSE
Last Name:LOVETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8235 SEHOME RD
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-9367
Mailing Address - Country:US
Mailing Address - Phone:208-597-0165
Mailing Address - Fax:
Practice Address - Street 1:3800 BYRON AVE
Practice Address - Street 2:UNIT 10B
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-6506
Practice Address - Country:US
Practice Address - Phone:360-930-6063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst