Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 39002436A | IN |
N | 101YP1600X | Pastoral Counselor | KY |
NPI | 1083833255 |
---|---|
Provider Name | Charles Robert Love |
First Address | New Albany, IN 47150-9426 |
Second Address | New Albany, IN 47150-9426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 30/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000766233 | ANTHEM (01) | IN |