Provider Demographics
NPI:1477879872
Name:LOVE, CHRISTOPHER MARTIN (PSYD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MARTIN
Last Name:LOVE
Suffix:
Gender:M
Credentials:PSYD
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 1572
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:CA
Mailing Address - Zip Code:92325-1572
Mailing Address - Country:US
Mailing Address - Phone:909-810-6426
Mailing Address - Fax:
Practice Address - Street 1:23739 LAKE DRIVE
Practice Address - Street 2:SUITE 207
Practice Address - City:CRESTLINE
Practice Address - State:CA
Practice Address - Zip Code:92325
Practice Address - Country:US
Practice Address - Phone:909-810-6426
Practice Address - Fax:909-658-6141
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 23377103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical