Provider Demographics
NPI:1447479001
Name:EVERLASTING COVENANT MINISTRY
Entity type:Organization
Organization Name:EVERLASTING COVENANT MINISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST-EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVETTE
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:269-372-5621
Mailing Address - Street 1:97 S LAKE DOSTER DR
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-9109
Mailing Address - Country:US
Mailing Address - Phone:269-372-5621
Mailing Address - Fax:
Practice Address - Street 1:97 S LAKE DOSTER DR
Practice Address - Street 2:
Practice Address - City:PLAINWELL
Practice Address - State:MI
Practice Address - Zip Code:49080-9109
Practice Address - Country:US
Practice Address - Phone:269-372-5621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0896741OtherBLUE CROSS BLUE SHIELD