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General NPI Number Information
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NPI Number | 1841735172
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Entity Type | Organization
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Legal Business Name | DR. LOVE AND ASSOCIATES PSYCHOLOGICAL PRACTICE
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Dates
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Enumeration Date | 12/22/2016
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Last Update Date | 12/22/2016
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Provider Practice Location Address
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Address Line | 5706 E MOCKINGBIRD LN STE 115-237
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City | DALLAS
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State | TX
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Zip | 75206-5460
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Country | US
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Telephone | 562-644-5185
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Fax |
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Provider Business Mailing Address
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Address Line | 5706 E MOCKINGBIRD LN STE 115-237
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City | DALLAS
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State | TX
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Zip | 75206-5460
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Country | US
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Telephone | 562-644-5185
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. DAVITTA LOVE
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Credential | PSYD
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Telephone | 562-644-5185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 37173
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License Number State | TX
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