Provider Demographics
NPI:1336184183
Name:LOVELACE, LANEEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:LANEEL
Middle Name:
Last Name:LOVELACE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:LANEEL
Other - Last Name:LOVELACE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:615 E MATTHEWS AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3145
Mailing Address - Country:US
Mailing Address - Phone:870-930-9090
Mailing Address - Fax:870-931-4581
Practice Address - Street 1:615 E MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3145
Practice Address - Country:US
Practice Address - Phone:870-930-9090
Practice Address - Fax:870-931-4581
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR03-08P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical