Provider Demographics
NPI:1144526047
Name:LOVE, JESSA RUTH (PHD, BCBA)
Entity type:Individual
Prefix:DR
First Name:JESSA
Middle Name:RUTH
Last Name:LOVE
Suffix:
Gender:F
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46200 PORT ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-6048
Mailing Address - Country:US
Mailing Address - Phone:734-454-0866
Mailing Address - Fax:734-454-1744
Practice Address - Street 1:46200 PORT ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-6048
Practice Address - Country:US
Practice Address - Phone:734-454-0866
Practice Address - Fax:734-454-1744
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst