Provider Demographics
NPI:1548835721
Name:LOVE, CHANEL (RD, LD)
Entity type:Individual
Prefix:
First Name:CHANEL
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15922 ELLENDALE CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4823
Mailing Address - Country:US
Mailing Address - Phone:713-377-8526
Mailing Address - Fax:
Practice Address - Street 1:15922 ELLENDALE CT
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-4823
Practice Address - Country:US
Practice Address - Phone:713-377-8526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83621133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty