Provider Demographics
NPI:1447732045
Name:LOVATO, KRISTIN SUE (LPC)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:SUE
Last Name:LOVATO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:KRISTIN
Other - Middle Name:SUE
Other - Last Name:MCKENZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2000 S FALCON DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295
Mailing Address - Country:US
Mailing Address - Phone:623-521-3427
Mailing Address - Fax:
Practice Address - Street 1:209 E BASELINE RD #E106
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283
Practice Address - Country:US
Practice Address - Phone:623-377-4226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17411101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional