Healthcare Provider Details

I. General information

NPI: 1033798160
Provider Name (Legal Business Name): KRISTY LOVE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 SPRUCE GLEN DR
CORDOVA TN
38018-7366
US

IV. Provider business mailing address

390 SPRUCE GLEN DR
CORDOVA TN
38018-7366
US

V. Phone/Fax

Practice location:
  • Phone: 901-604-0307
  • Fax:
Mailing address:
  • Phone: 901-604-0307
  • 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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1548803588
Identifier TypeMEDICAID
Identifier StateAR
Identifier Issuer

VIII. Authorized Official

Name: MRS. KRISTY DEVON SNIPES
Title or Position: THERAPIST
Credential: LCSW
Phone: 901-604-0307