Provider Demographics
NPI:1982622106
Name:LOVELAND, KATHERINE A (PHD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:LOVELAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 301173
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75303-1173
Mailing Address - Country:US
Mailing Address - Phone:713-500-3500
Mailing Address - Fax:
Practice Address - Street 1:1300 MOURSUND ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3406
Practice Address - Country:US
Practice Address - Phone:713-500-2500
Practice Address - Fax:713-500-2530
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-2984103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX040987201Medicaid
TX86785AOtherBCBS
TX86785AOtherBCBS
TX82853PMedicare PIN
TX680012832Medicare PIN