Provider Demographics
NPI:1598704124
Name:LOVE, JAMIE (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
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:PO BOX 1343
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-1343
Mailing Address - Country:US
Mailing Address - Phone:254-634-3007
Mailing Address - Fax:254-634-3280
Practice Address - Street 1:2100 TRIMMIER RD
Practice Address - Street 2:SUITE 103
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-8900
Practice Address - Country:US
Practice Address - Phone:254-634-3007
Practice Address - Fax:254-634-3280
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS091071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S76VMedicare ID - Type Unspecified