Provider Demographics
NPI:1235602806
Name:LIVE TO THRIVE, LLC
Entity Type:Organization
Organization Name:LIVE TO THRIVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MAED, LPCC-S
Authorized Official - Phone:330-422-8777
Mailing Address - Street 1:1532 STATE ROUTE 43 UNIT A
Mailing Address - Street 2:
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-8820
Mailing Address - Country:US
Mailing Address - Phone:330-422-8777
Mailing Address - Fax:330-967-0676
Practice Address - Street 1:1532 STATE ROUTE 43
Practice Address - Street 2:
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-8820
Practice Address - Country:US
Practice Address - Phone:330-701-6926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-07
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty