Provider Demographics
NPI:1720400104
Name:LOVEJOY, LARK (MS)
Entity type:Individual
Prefix:
First Name:LARK
Middle Name:
Last Name:LOVEJOY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LARK
Other - Middle Name:
Other - Last Name:MOBLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:745 PARK ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2503
Mailing Address - Country:US
Mailing Address - Phone:541-708-2024
Mailing Address - Fax:844-755-6401
Practice Address - Street 1:745 PARK ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2503
Practice Address - Country:US
Practice Address - Phone:541-708-2024
Practice Address - Fax:844-755-6401
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-20
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3649101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional