MEDICARE: ANDREA SMITH-LOVE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	73616	TX

General Provider Information

NPI Number	:	1053842393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA SMITH-LOVE LPC

Provider Business Mailing Address
First Line	:	3200 SANGUINET ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-5355
Country	:	US
Telephone Number	:	817-255-2686
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 W SANFORD ST
Second Line	:	SUITE 202
City	:	ARLINGTON
State	:	TX
Zip	:	76011-7086
Country	:	US
Telephone Number	:	817-255-2686
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2017
Last Update Date	:	03/27/2017

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Directions to “ ANDREA SMITH-LOVE LPC” Practice Location

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