Provider Demographics
NPI:1609122902
Name:LOVELACE, REGINA (BS)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:LOVELACE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8648 E PARKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73141-2238
Mailing Address - Country:US
Mailing Address - Phone:405-769-4141
Mailing Address - Fax:
Practice Address - Street 1:7250 NW EXPRESSWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-1534
Practice Address - Country:US
Practice Address - Phone:405-525-0452
Practice Address - Fax:405-525-0515
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation