Individual provider Active NPI

Olivia E Lovely, LMHC

  • Mental Health Counselor
  • Kelso, WA
National Provider Identifier
1679874770
Registry record updated Nov 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
60146914 Issued in WA
Practice address
305 Pacific Ave S Ste 102
Kelso, WA 98626-1638
Phone
(360) 577-7442
Fax
(360) 577-7904
NPI assigned
Nov 6, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 22, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 60480840 WA
Mental Health Counselor 101YM0800X LH60146914 WA
Mental Health Counselor 101YM0800X 60146914 WA Primary

Addresses

Primary practice location

305 Pacific Ave S Ste 102
Kelso, WA 98626-1638

Mailing address

PO Box 1847
Longview, WA 98632-8140
Phone (360) 423-0203

Other identifiers 1

IdentifierTypeStateIssuer
2089442MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
60480840WAMDCounselor
60146914WAMDMental Health Counselor
LH60146914WAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia Wellness CurrentSince Nov 24, 2019 Accepting new patients
C & R Executives, LLC Past Accepting new patients

Locations

305 Pacific Ave S
Ste 102
Kelso, WA 98626
Phone (360) 577-7442

921 14th Ave
Longview, WA 98632

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1289001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574380800000",
    "number": "1679874770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1847",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986328140",
            "telephone_number": "360-423-0203",
            "fax_number": "360-577-0269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 PACIFIC AVE S STE 102",
            "city": "KELSO",
            "state": "WA",
            "postal_code": "986261638",
            "telephone_number": "360-577-7442",
            "fax_number": "360-577-7904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOVELY",
        "first_name": "OLIVIA",
        "middle_name": "E",
        "name_prefix": "Ms.",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-11-06",
        "last_updated": "2019-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "60480840",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "LH60146914",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "60146914",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2089442",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kelso, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.