Healthcare Provider Details

I. General information

NPI: 1932879988
Provider Name (Legal Business Name): JUANITA LOVE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W GREENLAWN AVE STE 200
LANSING MI
48910-2889
US

IV. Provider business mailing address

16970 CHANDLER RD
EAST LANSING MI
48823-6101
US

V. Phone/Fax

Practice location:
  • Phone: 248-850-6600
  • Fax:
Mailing address:
  • Phone: 248-850-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: