Provider Demographics
NPI:1427318807
Name:LOVE, KEISHA M (PHD)
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:M
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:PO BOX 12262
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40582-2262
Mailing Address - Country:US
Mailing Address - Phone:859-420-7929
Mailing Address - Fax:859-963-1603
Practice Address - Street 1:2220 EXECUTIVE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-4870
Practice Address - Country:US
Practice Address - Phone:859-420-7929
Practice Address - Fax:859-963-1603
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-20
Last Update Date:2012-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1474103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling