1427600402 NPI number — KELSI MARIE LOVEJOY MSW, LCSW

Table of content: KELSI MARIE LOVEJOY MSW, LCSW (NPI 1427600402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427600402 NPI number — KELSI MARIE LOVEJOY MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOVEJOY
Provider First Name:
KELSI
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427600402
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 122
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINEDALE
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82941-0122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-360-7998
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 MAGNOLA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINEDALE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-734-6040
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LCSW-1406 . This is a "STATE OF WYOMING MENTAL HEALTH PROFESSIONAL LICENSING BOARD" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: PCSW-855 . This is a "PROVISIONAL CLINICAL SOCIAL WORKER" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".




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