Provider Demographics
NPI:1043468994
Name:LOVE, KELLY BREY (PHD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:BREY
Last Name:LOVE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2269 VERMILLION CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8614
Mailing Address - Country:US
Mailing Address - Phone:402-450-4882
Mailing Address - Fax:
Practice Address - Street 1:2269 VERMILLION CREEK DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8614
Practice Address - Country:US
Practice Address - Phone:402-450-4882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE702103T00000X
CO6001103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-080115226Medicaid