Provider Demographics
NPI:1639574940
Name:LOVE, LATISHA T (MA)
Entity Type:Individual
Prefix:
First Name:LATISHA
Middle Name:T
Last Name:LOVE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5610 CRAWFORDSVILLE ROAD
Mailing Address - Street 2:SUITE 701
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-3739
Mailing Address - Country:US
Mailing Address - Phone:317-241-4673
Mailing Address - Fax:317-241-0201
Practice Address - Street 1:5610 CRAWFORDSVILLE ROAD
Practice Address - Street 2:SUITE 701
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-3739
Practice Address - Country:US
Practice Address - Phone:317-241-4673
Practice Address - Fax:317-241-0201
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health