Provider Demographics
NPI:1891106167
Name:LOVE, SYLVIA
Entity Type:Individual
Prefix:
First Name:SYLVIA
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:PO BOX 849
Mailing Address - Street 2:
Mailing Address - City:LANGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73050-0849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:403 TOWNSEND
Practice Address - Street 2:
Practice Address - City:LANGSTON
Practice Address - State:OK
Practice Address - Zip Code:73050-0849
Practice Address - Country:US
Practice Address - Phone:405-620-4313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst