Provider Demographics
NPI:1558713545
Name:LOVE, CODY
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:LOVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 NE MLK JR BLVD
Mailing Address - Street 2:APT 4
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3083
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2955 NE MLK JR BLVD
Practice Address - Street 2:APT 4
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3083
Practice Address - Country:US
Practice Address - Phone:917-404-1729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker