Provider Demographics
NPI:1073291043
Name:LIVE WELL THERAPY
Entity Type:Organization
Organization Name:LIVE WELL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SCHMID-EGLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:612-801-3168
Mailing Address - Street 1:19022 EMBRY LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-9196
Mailing Address - Country:US
Mailing Address - Phone:612-801-3168
Mailing Address - Fax:
Practice Address - Street 1:6607 18TH AVE S STE 101
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2784
Practice Address - Country:US
Practice Address - Phone:612-801-3168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty