Provider Information for 1285205427
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Ms. WYLISA M LOVE LCSW
Other Names:Former Name:WYLISA M MCINTOSHSex: Female
NPI: 1285205427
Last Updated: 2024-12-13
Certification Date: 2024-12-13
Certification Date: 2024-12-13
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1285205427 | ||||||||
| Enumeration Date | 2021-07-08 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 5907 E 44TH ST INDIANAPOLIS, IN 46226-3307 United States Phone: 773-653-8548 | Fax: | ||||||||
| Primary Practice Address | 6002 E 38TH ST INDIANAPOLIS, IN 46226-5614 United States Phone: 317-880-6002 | Fax:317-880-0417 | ||||||||
| Secondary Practice Address(es) | 5907 E 44TH ST | ||||||||
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