Organization
OLD BAT INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GINA M LOVE PSYD (OWNER)
(734) 218-6644
Entity
Organization
Contact information
Practice address
623 W HURON ST, 2ND FLOOR, ANN ARBOR, MI 48103-6712
(734) 218-6644
(734) 956-5256
Mailing address
623 W HURON ST, 2ND FLOOR, ANN ARBOR, MI 48103-6712
(734) 218-6644
(734) 956-5256
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301011905
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H10564
BCBS IND PIN UNDER OBI
MI
01
—
0H10569
BCBS PIN
MI
01
—
1386684157
INDIVIDUAL NPI
MI
Enumeration date
06/29/2011
Last updated
07/23/2012
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