Provider Demographics
NPI:1972727840
Name:LOVE, MARY KATHLEEN (LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHLEEN
Last Name:LOVE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHLEEN
Other - Last Name:EGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5990 S VIVIAN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-2360
Mailing Address - Country:US
Mailing Address - Phone:303-972-0492
Mailing Address - Fax:
Practice Address - Street 1:7400 E ARAPAHOE RD
Practice Address - Street 2:SUITE 212
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1279
Practice Address - Country:US
Practice Address - Phone:303-741-1077
Practice Address - Fax:303-741-1078
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1234101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1234OtherPROFESSIONAL COUNSELOR