Provider Demographics
NPI:1255093753
Name:LOVE, BRENDA EVETTE (QMHA)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:EVETTE
Last Name:LOVE
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-8143
Mailing Address - Country:US
Mailing Address - Phone:469-980-0081
Mailing Address - Fax:
Practice Address - Street 1:5250 S PECOS RD # B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-1289
Practice Address - Country:US
Practice Address - Phone:775-699-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health