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General NPI Number Information
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NPI Number | 1457165136
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Entity Type | Organization
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Legal Business Name | LOVE COMMUNITY BEHAVIORAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 112 MEADOWCREST DR
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City | BELLEVILLE
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State | IL
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Zip | 62221-6749
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Country | US
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Telephone | 618-550-5028
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Fax |
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Provider Business Mailing Address
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Address Line | 112 MEADOWCREST DR
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City | BELLEVILLE
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State | IL
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Zip | 62221-6749
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Country | US
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Telephone | 618-550-5028
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Fax |
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Authorized Official
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Title or Position | PMHNP
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Name | SHIRLISA LOVE
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Credential |
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Telephone | 618-550-5028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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