MEDICARE: TRACY CHONTE LOVE

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	175T00000X	Peer Specialist		OK

General Provider Information

NPI Number	:	1578415055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY CHONTE LOVE

Provider Business Mailing Address
First Line	:	1458 N EVANSTON PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74110-4816
Country	:	US
Telephone Number	:	918-370-5471
Fax Number	:	918-370-5471

Provider Business Practice Location Address
First Line	:	1458 N EVANSTON PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74110-4816
Country	:	US
Telephone Number	:	918-370-5471
Fax Number	:	918-370-5471

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

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “ TRACY CHONTE LOVE ” Practice Location

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