Healthcare Provider Details

I. General information

NPI: 1275906257
Provider Name (Legal Business Name): HAROLD LOVE COUNSELING, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 S FERDON BLVD SUITE D3
CRESTVIEW FL
32536-4901
US

IV. Provider business mailing address

1455 S FERDON BLVD SUITE D3
CRESTVIEW FL
32536-4901
US

V. Phone/Fax

Practice location:
  • Phone: 850-398-8662
  • Fax: 850-398-8672
Mailing address:
  • Phone: 850-398-8662
  • Fax: 850-398-8672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5886
License Number StateFL

VIII. Authorized Official

Name: MR. HAROLD E LOVE
Title or Position: PRESIDENT
Credential: LMHC5886
Phone: 850-398-8662