Provider Demographics
NPI:1033798160
Name:KRISTY LOVE COUNSELING
Entity Type:Organization
Organization Name:KRISTY LOVE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:DEVON
Authorized Official - Last Name:SNIPES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:901-604-0307
Mailing Address - Street 1:390 SPRUCE GLEN DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-7366
Mailing Address - Country:US
Mailing Address - Phone:901-604-0307
Mailing Address - Fax:
Practice Address - Street 1:390 SPRUCE GLEN DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-7366
Practice Address - Country:US
Practice Address - Phone:901-604-0307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1548803588Medicaid