Provider Demographics
NPI:1033963764
Name:LIVE LIFE HEALED
Entity Type:Organization
Organization Name:LIVE LIFE HEALED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KURIA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:253-221-9843
Mailing Address - Street 1:5614 176TH ST E STE B103
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-9303
Mailing Address - Country:US
Mailing Address - Phone:253-693-8096
Mailing Address - Fax:
Practice Address - Street 1:2518 CHATEAU DR
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-1550
Practice Address - Country:US
Practice Address - Phone:253-693-8096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health