Provider Demographics
NPI:1205180205
Name:LIVE WELL COACHING INC
Entity Type:Organization
Organization Name:LIVE WELL COACHING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:GARTHWAIT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MCJ, LPC
Authorized Official - Phone:860-465-7877
Mailing Address - Street 1:111 CLUBHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:CT
Mailing Address - Zip Code:06249-1615
Mailing Address - Country:US
Mailing Address - Phone:860-465-7877
Mailing Address - Fax:
Practice Address - Street 1:269 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:CT
Practice Address - Zip Code:06248
Practice Address - Country:US
Practice Address - Phone:860-465-7877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002207101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty