Healthcare Provider Details

I. General information

NPI: 1437970043
Provider Name (Legal Business Name): KEYANA LICHELE LOVE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18635 N ELDRIDGE PKWY STE 102
TOMBALL TX
77377-3063
US

IV. Provider business mailing address

16738 NEEDLEPOINT DR
CONROE TX
77302-2339
US

V. Phone/Fax

Practice location:
  • Phone: 281-892-9986
  • Fax:
Mailing address:
  • Phone: 404-402-0012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number108470
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: