Provider Demographics
NPI:1760701270
Name:LESLIE C. LOVE, PH.D., PC
Entity Type:Organization
Organization Name:LESLIE C. LOVE, PH.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:989-466-9200
Mailing Address - Street 1:110 E SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1817
Mailing Address - Country:US
Mailing Address - Phone:989-466-9200
Mailing Address - Fax:989-466-9200
Practice Address - Street 1:110 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1817
Practice Address - Country:US
Practice Address - Phone:989-466-9200
Practice Address - Fax:989-466-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680B945060OtherBLUE CROSS BLUE SHIELD