Provider Demographics
NPI:1578351979
Name:LOVE, JERMAINE JERALD JERJUAN
Entity type:Individual
Prefix:
First Name:JERMAINE
Middle Name:JERALD JERJUAN
Last Name:LOVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 SIGNAL WAY APT 1307
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-1488
Mailing Address - Country:US
Mailing Address - Phone:832-242-8146
Mailing Address - Fax:
Practice Address - Street 1:710 HOUSTON ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3413
Practice Address - Country:US
Practice Address - Phone:832-223-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst