Basic Information
| Provider Information | |||||||||
| NPI: | 1003225897 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOVE | ||||||||
| FirstName: | NORMAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8626 LOWER SACRAMENTO RD #41 | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952191835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094782487 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8626 LOWER SACRAMENTO RD STE 41 | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952101835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094782487 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2014 | ||||||||
| LastUpdateDate: | 02/12/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 67295 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 101YA0400X | 01 | BEHAVIORAL HEALTH AND SOCIAL SERVICE PROVIDER | OTHER |