Provider Demographics
NPI:1164809190
Name:LOVE, LISA LYNNE (MSW LCSW CBIS)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:LYNNE
Last Name:LOVE
Suffix:
Gender:F
Credentials:MSW LCSW CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 LARAMIE AVE
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3003
Mailing Address - Country:US
Mailing Address - Phone:850-274-7299
Mailing Address - Fax:
Practice Address - Street 1:800 WERNER CT
Practice Address - Street 2:SUITE 205E
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1326
Practice Address - Country:US
Practice Address - Phone:850-274-7299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL131891041C0700X
WY10311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical