Provider Demographics
NPI:1811527807
Name:LOVE, ANDREA L (MA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:LOVE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:L
Other - Last Name:TYLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2543 NE 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4317
Mailing Address - Country:US
Mailing Address - Phone:503-447-4407
Mailing Address - Fax:
Practice Address - Street 1:2543 NE 92ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4317
Practice Address - Country:US
Practice Address - Phone:503-447-4407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-19
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR6535101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health