Provider Demographics
NPI:1821701731
Name:LOVE PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:LOVE PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOTHERAPIST
Authorized Official - Prefix:PROF
Authorized Official - First Name:EROS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIALOGOS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:715-350-8978
Mailing Address - Street 1:8845 RED BERYL DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-4276
Mailing Address - Country:US
Mailing Address - Phone:608-960-5953
Mailing Address - Fax:
Practice Address - Street 1:16 N CARROLL ST STE 450B
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2716
Practice Address - Country:US
Practice Address - Phone:608-960-5953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100165504Medicaid