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General NPI Number Information
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NPI Number | 1578351979
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Entity Type | Individual
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Provider Name | JERMAINE JERALD JERJUAN LOVE
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Gender | Male
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 710 HOUSTON ST
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City | RICHMOND
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State | TX
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Zip | 77469-3413
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Country | US
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Telephone | 832-223-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 11109 SIGNAL WAY APT 1307
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City | STAFFORD
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State | TX
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Zip | 77477-1488
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Country | US
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Telephone | 832-242-8146
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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