Provider Demographics
NPI:1346670197
Name:LOVE, GLENDA G (LCSW)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:G
Last Name:LOVE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E F ST STE C
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-1755
Mailing Address - Country:US
Mailing Address - Phone:661-706-3465
Mailing Address - Fax:
Practice Address - Street 1:112 E F ST
Practice Address - Street 2:STE C
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-1740
Practice Address - Country:US
Practice Address - Phone:661-706-3465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical