Healthcare Provider Details

I. General information

NPI: 1134898703
Provider Name (Legal Business Name): FOR THE LOVE OF YOU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E CENTER ST
HERNANDO MS
38632-2211
US

IV. Provider business mailing address

2851 STAGE VILLAGE CV
BARTLETT TN
38134-4683
US

V. Phone/Fax

Practice location:
  • Phone: 901-351-0962
  • Fax:
Mailing address:
  • Phone: 901-351-0962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: COLLIETTA BASSETT
Title or Position: OWNER/PROVIDER
Credential:
Phone: 901-240-4859