Provider Demographics
NPI:1992503353
Name:LOVELL, BRACKEN (AMFT)
Entity type:Individual
Prefix:
First Name:BRACKEN
Middle Name:
Last Name:LOVELL
Suffix:
Gender:
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 S 250 W STE 208
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-6747
Mailing Address - Country:US
Mailing Address - Phone:435-688-1111
Mailing Address - Fax:
Practice Address - Street 1:1173 S 250 W STE 208
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-6747
Practice Address - Country:US
Practice Address - Phone:435-688-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13723343-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist