Healthcare Provider Details

I. General information

NPI: 1376888966
Provider Name (Legal Business Name): LOVE LE KIRACOFE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 TURWILL LN
KALAMAZOO MI
49006-1931
US

IV. Provider business mailing address

03070 48 1/2 ST
GRAND JUNCTION MI
49056-9785
US

V. Phone/Fax

Practice location:
  • Phone: 269-327-7472
  • Fax:
Mailing address:
  • Phone: 269-330-9727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801088279
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: