Provider Demographics
NPI:1366613853
Name:LOVE, SUSAN M (MFT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:LOVE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-6403
Mailing Address - Country:US
Mailing Address - Phone:530-273-7002
Mailing Address - Fax:530-478-5703
Practice Address - Street 1:405 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-6403
Practice Address - Country:US
Practice Address - Phone:530-273-7002
Practice Address - Fax:530-478-5703
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 7779106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist