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General NPI Number Information
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NPI Number | 1477879872
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Entity Type | Individual
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Provider Name | CHRISTOPHER MARTIN LOVE PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 04/12/2010
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Last Update Date | 08/25/2010
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Provider Practice Location Address
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Address Line | 23739 LAKE DRIVE SUITE 207
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City | CRESTLINE
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State | CA
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Zip | 92325
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Country | US
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Telephone | 909-810-6426
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Fax | 909-658-6141
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Provider Business Mailing Address
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Address Line | PO BOX 1572
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City | CRESTLINE
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State | CA
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Zip | 92325-1572
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Country | US
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Telephone | 909-810-6426
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 23377
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License Number State | CA
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