Healthcare Provider Details

I. General information

NPI: 1457165136
Provider Name (Legal Business Name): LOVE COMMUNITY BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 MEADOWCREST DR
BELLEVILLE IL
62221-6749
US

IV. Provider business mailing address

112 MEADOWCREST DR
BELLEVILLE IL
62221-6749
US

V. Phone/Fax

Practice location:
  • Phone: 618-550-5028
  • Fax:
Mailing address:
  • Phone: 618-550-5028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHIRLISA LOVE
Title or Position: PMHNP
Credential:
Phone: 618-550-5028