Healthcare Provider Details

I. General information

NPI: 1407354483
Provider Name (Legal Business Name): MR. JOSHUA LOVE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MISSOURI AVE
JEFFERSONVILLE IN
47130-3082
US

IV. Provider business mailing address

2207 FREEDOM CIR
JEFFERSONVILLE IN
47130-6538
US

V. Phone/Fax

Practice location:
  • Phone: 812-288-4688
  • Fax: 317-858-8715
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number170566
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: