Healthcare Provider Details

I. General information

NPI: 1437657442
Provider Name (Legal Business Name): KELLEE A LOVE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1088 WASSERMAN WAY
BATAVIA OH
45103-1974
US

IV. Provider business mailing address

1501 MADISON RD
WALNUT HILLS OH
45206-1706
US

V. Phone/Fax

Practice location:
  • Phone: 513-735-8100
  • Fax: 513-354-7115
Mailing address:
  • Phone: 513-354-5200
  • Fax: 513-354-7115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.165497
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCIII.161805
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: