MEDICARE: REBECCA J LOVE MFT LADC

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	106H00000X	Marriage & Family Therapist	01080	NV

General Provider Information

NPI Number	:	1710268776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA J LOVE MFT LADC

Provider Business Mailing Address
First Line	:	7371 W CHARLESTON BLVD
Second Line	:	STE. 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1575
Country	:	US
Telephone Number	:	702-639-7609
Fax Number	:	702-778-8910

Provider Business Practice Location Address
First Line	:	7371 W CHARLESTON BLVD
Second Line	:	STE. 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1575
Country	:	US
Telephone Number	:	702-639-7609
Fax Number	:	702-778-8910

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

Provider Enumeration Date	:	09/05/2011
Last Update Date	:	01/04/2017

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