Provider Demographics
NPI:1376256735
Name:LOVE, ALEXIS JONA'E
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:JONA'E
Last Name:LOVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:JONA'E
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1425 TALL PINE WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-3709
Mailing Address - Country:US
Mailing Address - Phone:682-382-1108
Mailing Address - Fax:
Practice Address - Street 1:1425 TALL PINE WAY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-3709
Practice Address - Country:US
Practice Address - Phone:682-382-1108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist