Provider Demographics
NPI:1922325935
Name:LOVE, JEANETTE (MFT, CEAP, SAP)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:MFT, CEAP, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28915 THOUSAND OAKS BLVD APT 296
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2100
Mailing Address - Country:US
Mailing Address - Phone:805-427-0336
Mailing Address - Fax:
Practice Address - Street 1:6604 VESPER AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4621
Practice Address - Country:US
Practice Address - Phone:818-251-5211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist