Provider Demographics
NPI:1740751338
Name:LOVE, AJAH
Entity Type:Individual
Prefix:
First Name:AJAH
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6787 W TROPICANA AVE STE 241
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4759
Mailing Address - Country:US
Mailing Address - Phone:833-624-5400
Mailing Address - Fax:
Practice Address - Street 1:6787 W TROPICANA AVE STE 241
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4759
Practice Address - Country:US
Practice Address - Phone:833-624-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-08
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124069106H00000X
NV4295R106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1740751338Medicaid
NV250017644Medicaid