Provider Demographics
NPI:1336731348
Name:LOVELAND, LAURIE ALLPHIN (MED)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ALLPHIN
Last Name:LOVELAND
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 HIGH RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-2629
Mailing Address - Country:US
Mailing Address - Phone:801-492-9079
Mailing Address - Fax:
Practice Address - Street 1:1258 W SOUTH JORDAN PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4711
Practice Address - Country:US
Practice Address - Phone:801-255-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT200329-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health