Provider Demographics
NPI:1912083825
Name:LOVE, ANN MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:MARIE
Last Name:LOVE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10161 E PICKWICK CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-5239
Mailing Address - Country:US
Mailing Address - Phone:231-947-2292
Mailing Address - Fax:231-995-9226
Practice Address - Street 1:10161 E PICKWICK CT
Practice Address - Street 2:SUITE A
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-5239
Practice Address - Country:US
Practice Address - Phone:231-947-2292
Practice Address - Fax:231-995-9226
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL934427103TC1900X
MI6301007474103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling