Provider Demographics
NPI:1972171973
Name:LOVE, TERI (MS, CPC-INTERN)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:MS, CPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2558 MISTY OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2932
Mailing Address - Country:US
Mailing Address - Phone:702-374-6208
Mailing Address - Fax:
Practice Address - Street 1:400 SHADOW LN STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4355
Practice Address - Country:US
Practice Address - Phone:702-731-0909
Practice Address - Fax:702-826-4757
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI3179101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health