Provider Demographics
NPI:1396406799
Name:LIVE LOVE AND BE FREE COUNSELING
Entity Type:Organization
Organization Name:LIVE LOVE AND BE FREE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:MANRY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:925-709-4044
Mailing Address - Street 1:15396 N 83RD AVE STE G103
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5629
Mailing Address - Country:US
Mailing Address - Phone:925-709-4044
Mailing Address - Fax:
Practice Address - Street 1:15396 N 83RD AVE STE G103
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5629
Practice Address - Country:US
Practice Address - Phone:602-422-6062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-07
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty