Provider Demographics
NPI:1225835044
Name:LOVATO, LARRY ELISEO
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:ELISEO
Last Name:LOVATO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 SWALLOW DR SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-8186
Mailing Address - Country:US
Mailing Address - Phone:505-604-9992
Mailing Address - Fax:
Practice Address - Street 1:5001 INDIAN SCHOOL RD NE STE 200
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4082
Practice Address - Country:US
Practice Address - Phone:505-657-4161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health