Provider Demographics
NPI:1053620500
Name:LOVELL, ERIN MICHELLE
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MICHELLE
Last Name:LOVELL
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 1:3302 PINECANDLE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-5238
Mailing Address - Country:US
Mailing Address - Phone:281-467-2682
Mailing Address - Fax:832-592-9252
Practice Address - Street 1:7026 BELGOLD ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77066-1002
Practice Address - Country:US
Practice Address - Phone:281-467-2682
Practice Address - Fax:832-592-9252
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16042101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113154208Medicaid