Provider Demographics
NPI:1821143900
Name:LOVE, VICTOR WAYNE (LMFT, LCDC, LSOTP)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:WAYNE
Last Name:LOVE
Suffix:
Gender:M
Credentials:LMFT, LCDC, LSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13647 LEAFY ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-8627
Mailing Address - Country:US
Mailing Address - Phone:936-520-1938
Mailing Address - Fax:
Practice Address - Street 1:780 CLEPPER STE 202
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-3130
Practice Address - Country:US
Practice Address - Phone:936-520-1938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004012106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173496401Medicaid