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General NPI Number Information
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NPI Number | 1437970043
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Entity Type | Individual
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Provider Name | KEYANA LICHELE LOVE LMSW
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Gender | Female
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 18635 N ELDRIDGE PKWY STE 102
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City | TOMBALL
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State | TX
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Zip | 77377-3063
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Country | US
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Telephone | 281-892-9986
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Fax |
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Provider Business Mailing Address
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Address Line | 16738 NEEDLEPOINT DR
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City | CONROE
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State | TX
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Zip | 77302-2339
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Country | US
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Telephone | 404-402-0012
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 108470
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License Number State | TX
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