Provider Demographics
NPI:1649729575
Name:LOVERN, JOHN
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:LOVERN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 EAST CHAPEL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4607
Mailing Address - Country:US
Mailing Address - Phone:805-928-7361
Mailing Address - Fax:805-928-5742
Practice Address - Street 1:801 E CHAPEL ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4607
Practice Address - Country:US
Practice Address - Phone:805-928-7361
Practice Address - Fax:805-928-5742
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5064103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical