Provider Demographics
NPI:1164867784
Name:LOVE, LISA CUNNINGHAM (MS-LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CUNNINGHAM
Last Name:LOVE
Suffix:
Gender:F
Credentials:MS-LPC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:CUNNINGHAM
Other - Last Name:GATLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS-LPC
Mailing Address - Street 1:4009 COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2724
Mailing Address - Country:US
Mailing Address - Phone:580-612-6541
Mailing Address - Fax:580-298-9958
Practice Address - Street 1:4093 SUMMERHILL SQ
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2768
Practice Address - Country:US
Practice Address - Phone:580-612-6541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200111200AMedicaid
OK200484660BMedicaid